Micro-costing analysis of harm reduction services in office-based addiction treatment

The U.S. opioid crisis, driven by rising polysubstance use and limited access to treatment, continues to strain healthcare systems with nearly 87 % of people with substance use disorders (SUD) lacking addiction treatment and SUD-related hospitalizations increasing. Integration of harm reduction services (HRS) into office-based addiction treatment (OBAT) can reduce high-risk drug use, overdose, infection, and healthcare utilization. However, stigma and reimbursement barriers have hindered adoption. To inform future implementation, we conducted a micro-costing analysis of HRS integration in OBAT settings.

Using a retrospective, ingredients-based, micro-costing approach from the health system perspective, we estimated the upfront and operational costs associated with distributing pre-packaged harm reduction kits in three OBAT clinics in Pittsburgh, PA, and assessed the absolute costs of the program to determine affordability.

Between February 2024 and June 2024, a total of 784 kits were distributed, averaging 261 kits per site. The most popular kits distributed included fentanyl test strips (n = 155), wound care (n = 146), and xylazine test strips (n = 122). Total upfront costs were $1962.03, and 5-month operational costs were $5480.68 across all three sites. Thus, we estimated that HRS integration into OBAT settings would cost one site $654.01 upfront and $365.38 and $4384.54 to operate monthly and annually, respectively.

We found that the estimated costs of HRS integration into OBAT sites was affordable and on par with other medical supplies kept in clinic spaces. More research needs to be done to assess HRS cost-effectiveness in reducing healthcare utilization and patient morbidity.