{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:10:53Z","timestamp":1784275853038,"version":"3.55.0"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n People with opioid use disorder (OUD) are often hospitalized for emergent medical problems, but opioid use is seldom addressed during the inpatient stay. In a recent trial, patients randomized to Substance Use Treatment and Recovery Team (START), a hospital-based addiction consultation service, were more likely to initiate medication for opioid use disorder and be linked to OUD-focused follow-up care compared with patients receiving usual OUD care, which was at the discretion of the primary team.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the incremental cost-effectiveness of START from the health sector and limited societal perspectives relative to usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation was an incremental cost-effectiveness analysis based on the START trial, which was conducted at 3 major academic medical centers. START participants were adults with a probable OUD diagnosis documented during an inpatient hospitalization from November 2021 to September 2023. This economic evaluation used trial participant\u2013level cost and health outcomes data, supplemented with published data.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Two strategies were compared: (1) START and (2) usual care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Costs, quality-adjusted life year (QALYs), and incremental cost-effectiveness ratios (ICERs). ICERs were estimated using a Markov model over a 12-month horizon, with deterministic and probabilistic sensitivity analyses. ICERs were expressed as cost per QALY gained, with a willingness-to-pay threshold of USD $150\u202f000\/QALY.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 325 participants were randomized to the START (164 [50.5%]) or usual care (161 [49.5%]); 213 were male (66%) and the median (IQR) age was 41 (32-50) years. START implementation costs were $640 per patient (personnel, $602; training and onboarding, $38). Compared with usual care, START was associated with an incremental cost of $162 (95% UI, \u2212$93 to $179) and a gain in QALYs of 0.0103 (95% UI, 0.0102 to 0.0106) per person from a health sector perspective, leading to an ICER of $15\u202f750 (95% UI, $8742 to $17\u202f034) per QALY gained. The ICER was $20\u202f921 (95% UI, $13 747 to $22 190) per QALY gained from a limited societal perspective. Sensitivity analyses demonstrated that health care expenditures and intervention effectiveness were the strongest drivers of cost-effectiveness.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this trial-based economic evaluation, START was a cost-effective approach for addressing opioid use disorder in the inpatient setting by increasing the initiation of medication for OUD and linkage to OUD-focused care after discharge.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.11324","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:30:17Z","timestamp":1778160617000},"page":"e2611324","source":"Crossref","is-referenced-by-count":2,"title":["Cost-Effectiveness of the START Hospital Addiction Consultation Service for Opioid Use Disorder Treatment"],"prefix":"10.1001","volume":"9","author":[{"given":"Adeyemi","family":"Okunogbe","sequence":"first","affiliation":[{"name":"RAND, Arlington, Virginia"},{"name":"Lucent Partners, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Peltz","sequence":"additional","affiliation":[{"name":"RAND, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itai","family":"Danovitch","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison J.","family":"Ober","sequence":"additional","affiliation":[{"name":"RAND, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teryl K.","family":"Nuckols","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"issue":"25","key":"zoi260342r1","doi-asserted-by":"publisher","first-page":"567","DOI":"10.15585\/mmwr.mm7325a1","article-title":"Treatment for opioid use disorder: population estimates\u2014United States, 2022.","volume":"73","author":"Dowell","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi260342r4","doi-asserted-by":"publisher","first-page":"j1550","DOI":"10.1136\/bmj.j1550","article-title":"Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.","volume":"357","author":"Sordo","year":"2017","journal-title":"BMJ"},{"issue":"12","key":"zoi260342r5","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1111\/add.13479","article-title":"Adopting the \u2018cascade of care\u2019 framework: an opportunity to close the implementation gap in addiction care?","volume":"111","author":"Soc\u00edas","year":"2016","journal-title":"Addiction"},{"key":"zoi260342r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2025.112737","article-title":"Mortality during and following treatment with extended-release naltrexone based on data from two clinical trials.","volume":"274","author":"Gjersing","year":"2025","journal-title":"Drug Alcohol Depend"},{"issue":"7","key":"zoi260342r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.23954","article-title":"Opioid overdose after medication for opioid use disorder initiation following hospitalization or ED visit.","volume":"7","author":"Weiner","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi260342r8","doi-asserted-by":"publisher","first-page":"900","DOI":"10.7326\/ANNALS-24-03385","article-title":"Prevalence of hospitalizations among a national sample of us adults with substance use disorders.","volume":"178","author":"Bernstein","year":"2025","journal-title":"Ann Intern Med"},{"issue":"5","key":"zoi260342r9","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.5852","article-title":"Incidence of treatment for opioid use disorder following nonfatal overdose in commercially insured patients.","volume":"3","author":"Kilaru","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi260342r10","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1001\/jamainternmed.2025.0356","article-title":"Mortality among veterans with opioid use disorder after medical hospitalization.","volume":"185","author":"Incze","year":"2025","journal-title":"JAMA Intern Med"},{"key":"zoi260342r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2022.108924","article-title":"Identifying factors that contribute to burnout and resilience among hospital-based addiction medicine providers: a qualitative study.","volume":"144","author":"Bredenberg","year":"2023","journal-title":"J Subst Abuse Treat"},{"issue":"4","key":"zoi260342r12","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/ADM.0000000000000499","article-title":"Predictors for 30-day and 90-day hospital readmission among patients with opioid use disorder.","volume":"13","author":"Moreno","year":"2019","journal-title":"J Addict Med"},{"key":"zoi260342r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108350","article-title":"The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017.","volume":"218","author":"Florence","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"zoi260342r14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/CXA.0000000000000173","article-title":"The effectiveness of inpatient addiction consult services: a systematic review and narrative synthesis.","volume":"14","author":"Bahji","year":"2023","journal-title":"Can J Addict"},{"issue":"6","key":"zoi260342r15","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1001\/jamainternmed.2024.8586","article-title":"Hospital addiction consultation service and opioid use disorder treatment: the START randomized clinical trial.","volume":"185","author":"Ober","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi260342r16","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13722-022-00320-7","article-title":"The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder.","volume":"17","author":"Ober","year":"2022","journal-title":"Addict Sci Clin Pract"},{"issue":"7","key":"zoi260342r17","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1001\/jamapsychiatry.2021.0247","article-title":"Cost-effectiveness of treatments for opioid use disorder.","volume":"78","author":"Fairley","year":"2021","journal-title":"JAMA Psychiatry"},{"issue":"4","key":"zoi260342r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.7888","article-title":"Estimated clinical outcomes and cost-effectiveness associated with provision of addiction treatment in US primary care clinics.","volume":"6","author":"Jawa","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260342r19","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1016\/S2468-2667(21)00248-6","article-title":"Clinical impact, costs, and cost-effectiveness of hospital-based strategies for addressing the US opioid epidemic: a modelling study.","volume":"7","author":"Barocas","year":"2022","journal-title":"Lancet Public Health"},{"issue":"11","key":"zoi260342r20","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1111\/add.13900","article-title":"Cost-effectiveness of emergency department-initiated treatment for opioid dependence.","volume":"112","author":"Busch","year":"2017","journal-title":"Addiction"},{"issue":"3","key":"zoi260342r21","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.annemergmed.2024.10.001","article-title":"Cost-effectiveness of implementation facilitation to promote emergency department-initiated buprenorphine for opioid use disorder.","volume":"85","author":"Lu","year":"2025","journal-title":"Ann Emerg Med"},{"issue":"6","key":"zoi260342r22","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s40273-021-01112-8","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations.","volume":"40","author":"Husereau","year":"2022","journal-title":"Pharmacoeconomics"},{"key":"zoi260342r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2023.209063","article-title":"Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care.","volume":"150","author":"Ober","year":"2023","journal-title":"J Subst Use Addict Treat"},{"issue":"1","key":"zoi260342r25","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s13722-024-00461-x","article-title":"Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder.","volume":"19","author":"Evans","year":"2024","journal-title":"Addict Sci Clin Pract"},{"issue":"10","key":"zoi260342r26","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine.","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"issue":"1","key":"zoi260342r27","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13722-022-00299-1","article-title":"Factors associated with retention on medications for opioid use disorder among a cohort of adults seeking treatment in the community.","volume":"17","author":"Biondi","year":"2022","journal-title":"Addict Sci Clin Pract"},{"issue":"12","key":"zoi260342r28","doi-asserted-by":"publisher","first-page":"1868","DOI":"10.1038\/s41380-018-0094-5","article-title":"Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis.","volume":"24","author":"Ma","year":"2019","journal-title":"Mol Psychiatry"},{"issue":"4","key":"zoi260342r29","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1111\/add.13219","article-title":"Measuring benefits of opioid misuse treatment for economic evaluation: health-related quality of life of opioid-dependent individuals and their spouses as assessed by a sample of the US population.","volume":"111","author":"Wittenberg","year":"2016","journal-title":"Addiction"},{"issue":"10","key":"zoi260342r30","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1097\/MLR.0000000000001394","article-title":"Relative cost differences of initial treatment strategies for newly diagnosed opioid use disorder: a cohort study.","volume":"58","author":"Larochelle","year":"2020","journal-title":"Med Care"},{"issue":"11","key":"zoi260342r32","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1001\/jamapsychiatry.2020.1624","article-title":"Comparison of driving times to opioid treatment programs and pharmacies in the US.","volume":"77","author":"Kleinman","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"5","key":"zoi260342r33","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/JOM.0000000000001830","article-title":"Opioid use disorder and employee work presenteeism, absences, and health care costs.","volume":"62","author":"Henke","year":"2020","journal-title":"J Occup Environ Med"},{"issue":"1","key":"zoi260342r35","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1111\/1475-6773.12612","article-title":"Adjusting health expenditures for inflation: a review of measures for health services research in the United States.","volume":"53","author":"Dunn","year":"2018","journal-title":"Health Serv Res"},{"issue":"7","key":"zoi260342r39","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/j.jval.2019.03.003","article-title":"A new method to determine the optimal willingness to pay in cost-effectiveness analysis.","volume":"22","author":"Phelps","year":"2019","journal-title":"Value Health"},{"issue":"15","key":"zoi260342r40","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1001\/jama.2023.1792","article-title":"Cost-effectiveness thresholds used by study authors, 1990-2021.","volume":"329","author":"Neumann","year":"2023","journal-title":"JAMA"},{"issue":"1","key":"zoi260342r41","doi-asserted-by":"publisher","first-page":"25","DOI":"10.7326\/M20-1392","article-title":"A health opportunity cost threshold for cost-effectiveness analysis in the United States.","volume":"174","author":"Vanness","year":"2021","journal-title":"Ann Intern Med"},{"issue":"4","key":"zoi260342r42","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1097\/ADM.0b013e31829727b2","article-title":"Prior buprenorphine experience is associated with office-based buprenorphine treatment outcomes.","volume":"7","author":"Cunningham","year":"2013","journal-title":"J Addict Med"},{"issue":"7","key":"zoi260342r43","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1111\/ajad.12533","article-title":"Hospitalized opioid-dependent patients: exploring predictors of buprenorphine treatment entry and retention after discharge.","volume":"26","author":"Lee","year":"2017","journal-title":"Am J Addict"},{"key":"zoi260342r44","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109670","article-title":"Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states.","volume":"241","author":"Cole","year":"2022","journal-title":"Drug Alcohol Depend"},{"issue":"12","key":"zoi260342r46","doi-asserted-by":"publisher","first-page":"925","DOI":"10.2471\/BLT.15.164418","article-title":"Cost-effectiveness thresholds: pros and cons.","volume":"94","author":"Bertram","year":"2016","journal-title":"Bull World Health Organ"},{"issue":"9","key":"zoi260342r47","doi-asserted-by":"publisher","first-page":"2450","DOI":"10.1111\/add.15879","article-title":"Population-level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost-effectiveness analysis.","volume":"117","author":"Savinkina","year":"2022","journal-title":"Addiction"},{"issue":"1","key":"zoi260342r48","doi-asserted-by":"publisher","first-page":"10","DOI":"10.7326\/M17-0611","article-title":"Cost-effectiveness of publicly funded treatment of opioid use disorder in California.","volume":"168","author":"Krebs","year":"2018","journal-title":"Ann Intern Med"},{"issue":"10","key":"zoi260342r49","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1097\/MLR.0000000000001873","article-title":"The price of practice change: assessing the cost of integrating research findings into clinical practice.","volume":"61","author":"Lehman","year":"2023","journal-title":"Med Care"},{"key":"zoi260342r50","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2023.109778","article-title":"The cost of opioid use disorder-related conditions in Medicare.","volume":"244","author":"Mark","year":"2023","journal-title":"Drug Alcohol Depend"},{"key":"zoi260342r51","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2022.107345","article-title":"Total cost of care associated with opioid use disorder treatment.","volume":"166","author":"Toseef","year":"2023","journal-title":"Prev Med"},{"issue":"1","key":"zoi260342r52","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.52378","article-title":"Medical costs of substance use disorders in the US employer-sponsored insurance population.","volume":"6","author":"Li","year":"2023","journal-title":"JAMA Netw Open"},{"key":"zoi260342r3","volume-title":"Key Substance Use and Mental Health Indicators in the United States: Results from the","author":"Substance Abuse and Mental Health Services Administration","year":"2023"},{"key":"zoi260342r38","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781139506779","volume-title":"Decision Making in Health and Medicine: Integrating Evidence and Values","author":"Hunink","year":"2014"},{"key":"zoi260342r2","unstructured":"Drug overdose deaths: facts and figures. National Institute on Drug Abuse (NIDA). Accessed July 1, 2025. https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"zoi260342r23","unstructured":"Danovitch I, Ober AJ, Friedmann PD, Page K. Collaborative care teams for hospitalized patients with opioid use disorders: trial protocol and statistical analysis plan. Cedars-Sinai Medical Center. Accessed March 9, 2026. https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/instance\/11976642\/bin\/jamainternmed-e248586-s001.pdf"},{"key":"zoi260342r31","unstructured":"Annual averages\u2014household data\u2014tables from employment and earnings. Bureau of Labor Statistics. Accessed April 4, 2025. https:\/\/www.bls.gov\/cps\/cps_aa2022.htm"},{"key":"zoi260342r34","unstructured":"Using Appropriate Price Indices for Expenditure Comparisons. Agency for Healthcare Research and Quality. Accessed March 6, 2026. https:\/\/meps.ahrq.gov\/about_meps\/Price_Index.shtml"},{"key":"zoi260342r36","unstructured":"IRS issues standard mileage rates for 2023; business use increases 3 cents per mile. Internal Revenue Service. Accessed July 4, 2025. https:\/\/www.irs.gov\/newsroom\/irs-issues-standard-mileage-rates-for-2023-business-use-increases-3-cents-per-mile"},{"key":"zoi260342r37","unstructured":"Treatment improvement protocol\u2014TIP 63: medications for opioid use disorder. Substance Abuse and Mental Health Services Administration. Accessed July 3, 2025. https:\/\/library.samhsa.gov\/product\/tip-63-medications-opioid-use-disorder\/pep21-02-01-002"},{"key":"zoi260342r45","unstructured":"Occupational employment and wage statistics (OEWS) tables. US Bureau of Labor Statistics. Accessed April 26, 2025. https:\/\/www.bls.gov\/oes\/tables.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2848694\/okunogbe_2026_oi_260342_1779378690.66328.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T15:02:04Z","timestamp":1779807724000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2848694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":52,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.11324","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}