OUD Care Service Improvement with Prolonged-release Buprenorphine in Prisons: Cost Estimation Analysis

Figures & data

Table 1 Direct Costs: Utilization Rates

Cost Type		Utilization
Medication		Methadone	Prolonged-release buprenorphine
		Daily dose 60 mg	Monthly dose 8, 16, 24, 32 mg
Dispensing system		1^*	0^**
Staff	Process	Resource use^# (h/week)
Prison officer	Escort offenders	63.0	0.0
	Dispensing	31.5	0.0
Nurse	Setup	5.3	0.0
	Dispensing	31.5	6.0
	Completion	5.3	0.0
Pharmacy technician	Setup	5.3	0.0
	Dispensing	31.5	3.0
	Completion	5.3	0.0
	Weekly administration	16.5	3.0
Pharmacist	Weekly administration	25.5	9.8
Prescriber	Weekly administration	7.5	3.8

Notes: *One Methasoft system set up for a prison with 150 people in treatment. **Does not require automatic dispensing system. ^#Describes weekly staff resource required to serve 150 patients in treatment.

Table 2 Indirect Costs: Utilization Rates

Cost Type	Utilization (Events/Year)^a
	Methadone	Prolonged-release Buprenorphine	Reference
Indirect health care
Diversion-related medication review	780.00	0.00	^Citation30 Assumption
Overdose	156.00	78.00	^Citation30,Citation31^b
Ambulance call out for overdose	0.86	0.47	^Citation31,Citation32^b
Drug-related death (in custody)	0.04	0.02	^Citation31,Citation33^b
Drug-related death (post release)	0.75	0.45	^Citation31,Citation34^b
Indirect security/criminal justice
Adjudications for violence	52.5	36.00	^Citation30,Citation35^b
Sentence day added for violence	4.65	3.30	^Citation30,Citation35^b
Adjudication for diversion attempt	780.00	0.00	^Citation30 Assumption
Arrest (post release)	61.5	21.00	^Citation36,Citation37^b
Court appearance (post release)	61.5	21.00	^Citation36,Citation37^b

Notes: ^aNumber of occurrences annually per 150 patients in treatment ^bModel input values assumed based on extrapolation of referenced data.

Table 3 Unitary Costs

Cost Parameter	Unit Cost (£)	Reference
Medication
Methadone (1 mg/mL, oral solution)	0.54/60 mg dose	^Citation38
Prolonged-release buprenorphine	239.70/30-day supply	^Citation19
Logistics
Dispensing system fee	200.00/month	^Citation39
Staff, hourly rate
Prison officer	19.15	^Citation40
Nurse	22.70	^Citation41
Pharmacy technician	17.02	^Citation42
Pharmacist	28.37	^Citation43
Prescriber	67.38	^Citation44
Indirect healthcare
Medication review	17.00	^Citation30,Citation44
Overdose (staff resource)	195.00	^Citation30,Citation40,Citation41
Naloxone (400 μg/mL)	8.16	^Citation38
Ambulance callout	300.00	^Citation45
Drug-related death (in custody)	60,000.00	^Citation30
Drug-related death (post release)	60,000.00	^Citation30
Indirect security/criminal justice
Adjudication	30.00	^Citation30,Citation40
Added sentence day	103.00	^Citation46
Arrest	2199.68	^Citation47
Court appearance	1100.78	^Citation47

Table 4 Budgetary Impact Results

	Standard of Care	PRB Introduction	Difference
Patients in treatment (n)
Methadone	150	105	−45
Prolonged-release buprenorphine	0	45	+45
Annual costs (£)
Direct service cost
Medication cost	29,484	151,515	122,031
Dispensing system fee	3600	2520	−1080
Staff cost
Prison Officer	94,098	65,869	−28,229
Nurse	49,566	36,820	−12,746
Pharmacy technician	51,779	37,838	−13,940
Pharmacist	37,617	30,647	−6,970
Prescriber	26,277	22,335	−3941
Total direct service	£292,420	£347,544	£55,124
Indirect health-care costs
Diversion-related medication review	13,260	9282	−3978
Overdose (staff resource)	30,420	25,857	−4563
Naloxone	1273	1082	−191
Ambulance callout	255	217	−38
Drug-related death (in custody)	2494	2120	−374
Drug-related death (postrelease)	48,930	41,591	−7340
Total indirect health care	£96,632	£80,148	–£16,484
Indirect security/criminal justice costs
Adjudication: drug-related violence	1572	1431	−142
Adjudication: diversion	23,400	16,380	−7020
Sentence extension: drug-related violence	475	432	−43
Arrests	135,280	108,554	−26,726
Court Appearances	67,698	54,323	−13,374
Total indirect security/criminal justice	£228,425	£181,120	–£47,305
Total	£617,477	£608,813	–£8665

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