This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.
State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.
We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
方法:本研究以社区视角为指导,反映了现实世界社区实施CTH干预所需的投资。我们采用了基于活动的成本计算方法,其中与招聘相关的资源,培训,采购,通过来自34个致命阿片类药物过量发生率高的社区的宏观和微观成本计算技术,确定了社区仪表板的创建,在四个州——肯塔基州,马萨诸塞州,纽约,俄亥俄州。使用行政和半结构化访谈数据确定了资源并分配了单位成本。所有成本估算均以2019年美元报告。
结果:州级平均和启动成本中位数(代表每个州8-10个社区)分别为268,657美元和175,683美元。招聘和培训占40%,设备和基础设施成本占24%,仪表板创建占总平均启动成本的36%。相对而言,招聘和培训占49%,采购成本占18%,仪表板创建占总启动成本中位数的34%。
结论:我们确定了影响启动成本的三种不同的CTH招聘模式:医院-学术(马萨诸塞州),大学学术(肯塔基州和俄亥俄州),和社区杠杆化(纽约)。招聘,培训,由于现有的当地基础设施,购买启动成本在纽约最低。由于利用现有基础设施,类似于纽约模式的基于社区的实施可能具有较低的启动成本。关系,以及当地卫生部门的支持。