Table 4.
Primary and Secondary Outcomes in the First Year of Buprenorphine Treatment Implementation (Year 1) and in Each Subsequent Year (After Year 1 for Each of 10 Years) Across 4 Approaches for Office-Based Opioid Treatment With Buprenorphine, and Among the Different Simulated Practice Types
| Gross Revenue $ (95% CI) | Opportunity Costs $ (95% CI) | New Personnel and Overhead Costs $ (95% CI) | Net Revenue $ (95% CI) | |
|---|---|---|---|---|
| Year 1 | ||||
| FQHC | ||||
| Physician-led | 41,769 (17,408-73,092) | 6,395 (2,517-12,393) | 6,514 (3,508-10,647) | 28,859 (9,247-54,294) |
| Nurse-led | 35,857 (15,013-63,183) | 3,240 (1,438-5,964) | 9,746 (4,929-16,344) | 22,870 (6,258-45,087) |
| Shared | 41,942 (17,390-73,618) | 4,081 (1,716-7,573) | 9,193 (4,700-15,475) | 28,668 (9,026-55,032) |
| Solo | 29,656 (12,298-52,300) | 7,880 (3,374-14,569) | 0 | 21,776 (7,964-40,045) |
| Urban | ||||
| Physician-led | 59,641 (27,589-104,484) | 7,508 (3,471-13,481) | 6,364 (3,632-9,832) | 45,769 (17,812-85,568) |
| Nurse-led | 54,576 (24,983-96,817) | 3,996 (2,014-6,793) | 8,974 (5,062-14,234) | 41,606 (15,280-79,472) |
| Shared | 59,046 (27,545-103,358) | 4,931 (2,429-8,497) | 8,521 (4,810-13,509) | 45,593 (17,826-85,198) |
| Solo | 35,112 (16,659-61,275) | 9,552 (4,779-16,355) | 0 | 25,560 (10,299-47,435) |
| Rural | ||||
| Physician-led | 85,035 (34,078-157,980) | 10,027 (4,086-19,218) | 5,642 (2,966-9,378) | 69,366 (24,814-134,442) |
| Nurse-led | 77,939 (30,947-146,822) | 5,041 (2,317-9,133) | 8,575 (4,285-14,885) | 64,323 (22,021-126,578) |
| Shared | 84,142 (34,404-155,899) | 6,368 (2,838-11,789) | 8,092 (4,091-14,110) | 69,682 (24,761-134,089) |
| Solo | 49,895 (20,589-92,754) | 12,299 (5,549-22,553) | 0 | 37,596 (13,617-73,853) |
| Other | ||||
| Physician-led | 45,677 (10,184-97,483) | 5,976 (2,115-12,076) | 6,302 (3,338-10,049) | 33,399 (2,990-79,070) |
| Nurse-led | 42,193 (9,386-91,756) | 3,399 (1,506-6,194) | 8,296 (4,168-14,212) | 30,499 (2,065-75,037) |
| Shared | 45,116 (10,211-96,573) | 4,078 (1,696-7,662) | 7,929 (3,949-13,301) | 33,108 (2,651-79,258) |
| Solo | 26,085 (5,935-55,506) | 7,944 (3,303-14,887) | 0 | 18,141 (1,702-42,051) |
| Year 2+ | ||||
| FQHC | ||||
| Physician-led | 41,769 (17,408-73,092) | 5,519 (1,779-11,327) | 3,234 (1,159-6,404) | 33,016 (13,567-58,589) |
| Nurse-led | 35,857 (15,013-63,183) | 2,357 (749-4,925) | 6,455 (2,345-12,448) | 27,044 (10,820-49,205) |
| Shared | 41,942 (17,390-73,618) | 3,204 (1,024-6,509) | 5,903 (2,108-11,579) | 32,835 (13,388-59,298) |
| Solo | 29,656 (12,298-52,300) | 6,119 (1,979-12,547) | 0 | 23,538 (9,683-41,899) |
| Urban | ||||
| Physician-led | 59,641 (27,589-104,484) | 6,153 (2,333-12,012) | 2,660 (1,145-5,016) | 50,828 (22,860-90,418) |
| Nurse-led | 54,576 (24,983-96,817) | 2,631 (977-5,113) | 5,257 (2,237-9,696) | 46,688 (20,264-84,319) |
| Shared | 59,046 (27,545-103,358) | 3,575 (1,358-6,884) | 4,806 (2,053-8,917) | 50,664 (23,090-90,283) |
| Solo | 35,112 (16,659-61,275) | 6,829 (2,576-13,015) | 0 | 28,283 (12,938-50,689) |
| Rural | ||||
| Physician-led | 85,035 (34,078-157,980) | 8,716 (2,901-17,783) | 3,671 (1,337-7,339) | 72,649 (28,513-137,390) |
| Nurse-led | 77,939 (30,947-146,822) | 3,721 (1,228-7,608) | 5,786 (2,116-11,413) | 68,432 (26,186-130,898) |
| Shared | 84,142 (34,404-155,899) | 5,058 (1,703-10,353) | 5,305 (1,945-10,692) | 73,779 (29,224-138,600) |
| Solo | 49,895 (20,589-92,754) | 9,664 (3,263-19,592) | 0 | 40,231 (16,037-76,726) |
| Other | ||||
| Physician-led | 45,677 (10,184-97,483) | 4,512 (1,107-7,623) | 2,080 (427-4,650) | 39,085 (8,650-85,210) |
| Nurse-led | 42,193 (9,386-91,756) | 1,923 (371-4,339) | 4,058 (860-9,042) | 36,212 (7,785-80,774) |
| Shared | 45,116 (10,211-96,573) | 2,615 (503-5,939) | 3,695 (813-8,171) | 38,806 (8,649-84,639) |
| Solo | 26,085 (5,935-55,506) | 5,000 (983-11,455) | 0 | 21,086 (4,697-45,406) |
FQHC = federally qualified health center.
Note: The 4 approaches were (1) buprenorphine therapy via prescriber-led visits, which involved prescribers leading routine visits for medication management with a nurse care manager providing program coordination, intake visits, telephone outreach, and induction management, (2) buprenorphine therapy via nurse-led visits, which involved a nurse care manager leading patient visits and care management and prescribers meeting the patient every 3 months after induction for medication management, (3) buprenorphine therapy via shared medical appointments, which involved the prescribers leading a weekly group visit (including medication titration) in concert with a behaviorist and nurse care manager, and (4) buprenorphine therapy via a solo prescriber, which involved the physician prescribing buprenorphine without major structural support from auxiliary staff. The 4 practice types were (1) FQHCs and FQHC look-alikes, (2) non-FQHC practices in high-poverty urban areas by Census definition (>20% of households within the ZIP Code having an income below the federal poverty threshold after adjustment for household size), (3) non-FQHC practices in high-poverty rural areas by Census definition (>20% of households within the ZIP Code having an income below the federal poverty threshold after adjustment for household size), and (4) practices outside of high-poverty areas.