Table 2.
Implementation costs for different units of measure (eg, cost per primary care visit) based on sample sizes from Kaiser Permanente Washington Health System over a 1‐year period
| Unit of measure | Assumptions | Number of units | Cost per Unit |
|---|---|---|---|
| General primary care population | |||
| Total population in health system | Size of enrolled population | 400 000 | $4 |
| PC site | Number of PC sites | 25 | $63 486 |
| PC provider a | Number of PC providers | 460 | $3450 |
| PC visit | 90% of enrolled with PC visit | 360 000 | $4 |
| PC visits with BHI screening b | 89% of PC visits were screened | 320 400 | $5 |
| Primary care patients who completed BHI screening | |||
| Depression and self‐harm | |||
| Positive depression screen (ie, PHQ‐2 ≥ score 2 on either item) | 17.0% of screened patients | 54 468 | $29 |
| Assessed for depression (ie, completed PHQ‐9) | 16.3% of screened patients | 52 289 | $30 |
| Identified with moderate to severe depression (ie, PHQ‐9 ≥ 10) | 12.8% of screened patients | 40 851 | $39 |
| Identified with frequent thoughts of self‐harm (ie, PHQ‐9 Q#9 2‐3) | 0.7% of screened patients | 2092 | $759 |
| Alcohol use | |||
| Positive alcohol screen (ie, AUDIT‐C ≥ 3 for women; ≥4 for men) | 22.0% of screened patients | 70 488 | $23 |
| Positive screen for high‐risk alcohol use (ie, AUDIT‐C score ≥ 7) | 2.0% of screened patients | 6408 | $248 |
| High‐risk alcohol use and assessed with Alcohol Symptom Checklist | 1.3% of screened patients | 4037 | $393 |
| Identified with high‐risk alcohol use and ≥ 2 DSM‐5 symptoms of alcohol use disorder | 0.7% of screened patients | 2099 | $756 |
| Other substance use | |||
| Positive cannabis screen (daily cannabis use) | 4.0% of screened patients | 12 816 | $124 |
| Daily cannabis use and assessed with Substance Use Symptom Checklist | 2.4% of screened patients | 7690 | $206 |
| Identified with daily cannabis use and ≥ 2 DSM‐5 symptoms of SUD | 0.7% of screened patients | 2384 | $666 |
| Positive screen for any other (ie, noncannabis) drug use | 1.0% of screened patients | 3204 | $495 |
| Any other drug use and assessed with Substance Use Symptom Checklist | 0.7% of screened patients | 2083 | $762 |
| Identified with any other drug use and ≥ 2 DSM‐5 symptoms of SUD | 0.3% of screened patients | 875 | $1815 |
| Aggregate | |||
| Identified: depression, suicidal thoughts, and/or alcohol or SUD. | 13.0% of screened patients | 41 540 | $38 |
Abbreviations: AUDIT‐C, The Alcohol Use Disorders Identification Test‐Consumption questions; BHI, Behavioral Health Integration; DSM‐5, Diagnostic and Statistical Manual of Mental Disorders‐fifth edition; PC, Primary Care; PHQ‐2 or PHQ‐9, Patient Health Questionnaires‐2 or 9; SUD, substance use disorders.
Estimate includes pediatric, part time, and temporary providers.
Seven item BHI screen includes PHQ‐2, AUDIT‐C, 1 question about frequency of past‐year cannabis use, 1 question about frequency of past‐year illicit drug use (or nonmedical use of prescription medication).