Economic analysis of a low-threshold mobile medical unit dispensing buprenorphine for opioid use disorder

Abstract

Background

The University of Illinois Chicago (UIC) Community Outreach Intervention Project (COIP) established a low-threshold mobile medical unit that is among the first to carry and dispense buprenorphine on-site at point of care in Chicago neighborhoods with high opioid overdose rates. A deeper understanding of the mobile medical unit implementation and operation costs is needed to inform sustainability and financial planning for healthcare systems across the country. This study measured the implementation, operation, and indirect patient costs of the UIC COIP mobile medical unit.

Methods

We conducted three analyses to determine start-up, direct fixed operating, direct variable operating, and indirect costs of the UIC COIP mobile medical unit. (1) Micro-costing of administrative purchasing records and on-site time-motion studies determined operation costs. (2) Interviews with staff and providers identified resources and time invested in implementation, and supplemented time-motion observations. (3) Interviews with patients collected indirect costs (i.e. transportation time/cost, missed commitments, perceived alternatives). Additionally, we conducted sensitivity analyses to assess uncertainty in resources used, costs, and mobile medical unit operation assumptions.

Results

The startup costs for a mobile medical unit with buprenorphine dispensing capabilities were $148,690, including buildout, supplies, and labor. Annual fixed operating costs were $131,040, encompassing vehicle operations (i.e. fuel, maintenance) and resources for medical operations (i.e. cellular network, urine testing). Variable operating costs included patient care cost of $85.24 per patient, and aggregate salaries for staff on the mobile medical unit, which were $1082 per day. Indirect patient costs were assessed in 30 individuals; the average transportation time to the care site was 35 min, most individuals did not miss other obligations to present for care, and 40% of individuals would not seek care elsewhere if the mobile unit was not available.

Conclusion

We report start-up and operation costs of a mobile medical unit that provides care and on-site buprenorphine dispensing in Chicago neighborhoods with high need. Understanding the implementation and operation costs of a low-threshold mobile medical unit is imperative to justify the continuation and expansion, as well as inform future research assessing the value and cost-effectiveness of such an intervention for the health system and community.