Abstract：
OBJECTIVE: To determine the budget impact of implementing multidisciplinary complex pain clinics (MCPCs) for Veterans Health Administration (VA) patients living with complex chronic pain and substance use disorder comorbidities who are on risky opioid regimens.
METHODS: We measured implementation costs for three MCPCs over 2 years using micro-costing methods. Intervention and downstream costs were obtained from the VA Managerial Cost Accounting System from 2 years prior to 2 years after opening of MCPCs.
METHODS: Staff at the three VA sites implementing MCPCs were supported by Implementation Facilitation. The intervention cohort was patients at MCPC sites who received treatment based on their history of chronic pain and risky opioid use. Intervention costs and downstream costs were estimated with a quasi-experimental study design using a propensity score-weighted difference-in-difference approach. The healthcare utilization costs of treated patients were compared with a control group having clinically similar characteristics and undergoing the standard route of care at neighboring VA medical centers. Cancer and hospice patients were excluded.
METHODS: Activity-based costing data acquired from MCPC sites were used to estimate implementation costs. Intervention and downstream costs were extracted from VA administrative data.
RESULTS: Average Implementation Facilitation costs ranged from $380 to $640 per month for each site. Upon opening of three MCPCs, average intervention costs per patient were significantly higher than the control group at two intervention sites. Downstream costs were significantly higher at only one of three intervention sites. Site-level differences were due to variation in inpatient costs, with some confounding likely due to the COVID-19 pandemic. This evidence suggests that necessary start-up investments are required to initiate MCPCs, with allocations of funds needed for implementation, intervention, and downstream costs.
CONCLUSIONS: Incorporating implementation, intervention, and downstream costs in this evaluation provides a thorough budget impact analysis, which decision-makers may use when considering whether to expand effective programming.
METHODS: We measured implementation costs for three MCPCs over 2 years using micro-costing methods. Intervention and downstream costs were obtained from the VA Managerial Cost Accounting System from 2 years prior to 2 years after opening of MCPCs.
METHODS: Staff at the three VA sites implementing MCPCs were supported by Implementation Facilitation. The intervention cohort was patients at MCPC sites who received treatment based on their history of chronic pain and risky opioid use. Intervention costs and downstream costs were estimated with a quasi-experimental study design using a propensity score-weighted difference-in-difference approach. The healthcare utilization costs of treated patients were compared with a control group having clinically similar characteristics and undergoing the standard route of care at neighboring VA medical centers. Cancer and hospice patients were excluded.
METHODS: Activity-based costing data acquired from MCPC sites were used to estimate implementation costs. Intervention and downstream costs were extracted from VA administrative data.
RESULTS: Average Implementation Facilitation costs ranged from $380 to $640 per month for each site. Upon opening of three MCPCs, average intervention costs per patient were significantly higher than the control group at two intervention sites. Downstream costs were significantly higher at only one of three intervention sites. Site-level differences were due to variation in inpatient costs, with some confounding likely due to the COVID-19 pandemic. This evidence suggests that necessary start-up investments are required to initiate MCPCs, with allocations of funds needed for implementation, intervention, and downstream costs.
CONCLUSIONS: Incorporating implementation, intervention, and downstream costs in this evaluation provides a thorough budget impact analysis, which decision-makers may use when considering whether to expand effective programming.
摘要：
目的：确定对退伍军人健康管理局（VA）患者实施多学科复杂疼痛诊所（MCPCs）的预算影响，这些患者患有复杂的慢性疼痛和药物使用障碍合并症，并接受危险的阿片类药物治疗。
方法：我们使用微观成本计算方法测量了三个MCPC在2年内的实施成本。干预和下游成本是从VA管理成本会计系统中获得的，该系统在MCPC开业后的2年之前。
方法：三个VA站点实施MCPC的工作人员得到了实施促进的支持。干预队列是MCPC站点的患者，他们根据其慢性疼痛和危险的阿片类药物使用史接受治疗。干预成本和下游成本是通过准实验研究设计使用倾向得分加权差异方法估算的。将接受治疗的患者的医疗保健利用成本与具有临床相似特征并在邻近的VA医疗中心接受标准护理途径的对照组进行比较。癌症和临终关怀患者被排除在外。
方法：使用从MCPC站点获取的基于活动的成本计算数据来估算实施成本。从VA管理数据中提取干预和下游成本。
结果：每个站点的平均实施促进成本从每月380美元到640美元不等。三个MCPC开业后，在两个干预点,每名患者的平均干预费用显著高于对照组.只有三个干预地点之一的下游成本明显更高。站点级别的差异是由于住院费用的变化，一些混淆可能是由于COVID-19大流行。这些证据表明，启动MCPC需要必要的启动投资，随着实施所需资金的分配，干预，和下游成本。
结论：结合实施，干预，和下游成本在本次评估中提供了全面的预算影响分析，决策者在考虑是否扩展有效的编程时可以使用哪些。
方法：我们使用微观成本计算方法测量了三个MCPC在2年内的实施成本。干预和下游成本是从VA管理成本会计系统中获得的，该系统在MCPC开业后的2年之前。
方法：三个VA站点实施MCPC的工作人员得到了实施促进的支持。干预队列是MCPC站点的患者，他们根据其慢性疼痛和危险的阿片类药物使用史接受治疗。干预成本和下游成本是通过准实验研究设计使用倾向得分加权差异方法估算的。将接受治疗的患者的医疗保健利用成本与具有临床相似特征并在邻近的VA医疗中心接受标准护理途径的对照组进行比较。癌症和临终关怀患者被排除在外。
方法：使用从MCPC站点获取的基于活动的成本计算数据来估算实施成本。从VA管理数据中提取干预和下游成本。
结果：每个站点的平均实施促进成本从每月380美元到640美元不等。三个MCPC开业后，在两个干预点,每名患者的平均干预费用显著高于对照组.只有三个干预地点之一的下游成本明显更高。站点级别的差异是由于住院费用的变化，一些混淆可能是由于COVID-19大流行。这些证据表明，启动MCPC需要必要的启动投资，随着实施所需资金的分配，干预，和下游成本。
结论：结合实施，干预，和下游成本在本次评估中提供了全面的预算影响分析，决策者在考虑是否扩展有效的编程时可以使用哪些。
