Health care cost trajectories in the year prior to and following intake into Veterans Health Administration outpatient substance use disorders treatment.

Veterans Health Administration (VHA) patients with substance use disorder (SUD) diagnoses incur significantly higher overall health care costs compared to the average annual costs of VHA patients. Because SUDs are relapsing/remitting chronic illnesses, it is important to understand how service costs shift over time in relation to active SUD treatment episodes in order to identify strategies which may enhance treatment outcomes and thereby reduce costs. The primary aim of the current study was to examine VHA health care costs derived from VHA administrative data for 330 Veterans during the years prior to and following patient entry into outpatient SUD treatment in two VHA facilities. Secondary aims were to examine the impact on treatment costs of patient diagnosis (alcohol dependence only vs. stimulant dependence) and participation in an abstinence incentive intervention. There was a significant effect of time on health care costs (p<0.001). Average total costs per patient per quarter were $2204 for quarters 1 through 3, increased significantly to $7507 in quarter 4 and $8030 in quarter 5, then decreased significantly to $3969 in quarters 6 through 8. Increases in quarter 4 and 5 were attributable to inpatient costs whereas increases in the quarters following treatment entry were attributable to outpatient costs (quarters 5-8). Overall costs for patients with alcohol dependence only were approximately 30% higher than overall costs for patients whose diagnoses included stimulant dependence, attributable to higher outpatient costs. There was no significant effect of the 8-week incentive intervention on post-treatment entry costs. Overall, entering SUD treatment corresponded to an increase in health care costs in the quarters both immediately preceding and immediately following treatment entry followed by a tapering down of costs through 12month follow-up; however, longer follow-up is needed to inform the stability of this pattern. Additional research will be needed to determine whether efforts to increase access to SUD treatment, identify patients with SUD earlier on in the course of their disorder and integrate SUD treatment services into primary care settings may assist in engaging patients in treatment prior to experiencing a mental or physical health crisis requiring inpatient treatment and thereby reduce health care costs associated with SUD diagnoses.