{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:47:12Z","timestamp":1792788432281,"version":"4.5.0"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Overdose is the leading cause of death among people experiencing homelessness (PEH), but engagement in medication treatment is low in this population. Shelter-based buprenorphine may be a strategy for increasing initiation and retention on lifesaving medications.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate clinical outcomes and conduct an economic analysis of statewide shelter-based opioid treatment in Massachusetts.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation study in Massachusetts used a cohort state-transition simulation model. Two cohorts were modeled starting in 2013, including (1) a closed cohort of a fixed population of PEH with history of high-risk opioid use over their lifetimes and (2) an open cohort in which membership could change over time, allowing assessment of population-level trends over a 10-year period. Data analysis occurred from January 2023 to April 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Model exposures included (1) no shelter-based buprenorphine (status quo) and (2) offering buprenorphine in shelters statewide.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Outcomes included overdose deaths, quality-adjusted life-years (QALYs) gained, and health care and modified societal perspective costs. Sensitivity analyses were conducted on key parameters.<\/jats:p><\/jats:sec>Results<\/jats:title>In the closed cohort analysis of 13\u202f800 PEH (mean [SD] age, 40.4 [13.1] years; 8749 male [63.4%]), shelter-based buprenorphine was associated with an additional 65.4 person-weeks taking buprenorphine over an individual\u2019s lifetime compared with status quo. Shelter-based buprenorphine was cost saving when compared with the status quo, with a discounted lifetime cost savings from the health sector perspective of $1300 per person, and 0.2 additional discounted QALYs per person and 0.9 additional life-years per person. In the population-level simulation, 254 overdose deaths were averted over the 10-year period with the shelter-based buprenorphine strategy compared with the status quo (a 9.2% reduction of overdose deaths among PEH in Massachusetts). Overdose-related and other health care utilization undiscounted costs decreased by $3.0 million and $66.4 million, respectively. Shelter-based opioid treatment generated $44.7 million in additional medication and clinical costs, but saved $69.4 million in overdose and other health costs.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this economic evaluation of clinical and economic outcomes among PEH, shelter-based buprenorphine was associated with fewer overdose deaths and was cost saving. These findings suggest that broad rollout of shelter-based buprenorphine may be an important tool in addressing the overdose crisis.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.37233","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T15:04:01Z","timestamp":1729091041000},"page":"e2437233","source":"Crossref","is-referenced-by-count":6,"title":["Health and Economic Outcomes of Offering Buprenorphine in Homeless Shelters in Massachusetts"],"prefix":"10.1001","volume":"7","author":[{"given":"Avik","family":"Chatterjee","sequence":"first","affiliation":[{"name":"Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily 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