Financial Implications to Primary Care Practices of Alternative Buprenorphine-based Opioid Addiction Treatment Strategies: A Microsimulation Model

Sanjay Basu1,2,3☨*,Jonathan E. Fried1☨, Russell S. Phillips1,4, Bruce E. Landon1,4,5

☨ Contributed equally to this work. 1 Center for Primary Care, Harvard Medical School 2 Research and Analytics, Collective Health 3 School of Public Health, Imperial College London 4 Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center 5 Department of Health Care Policy, Harvard Medical School

• to whom correspondence should be addressed: sanjay_basu@hms.harvard.edu

Although office-based opioid treatment with buprenorphine is a cost-effective and clinically effective therapy for opioid use disorder, the impact of offering this treatment on primary care practice finances is uncertain. This study aimed to estimate how office-based opioid treatment with buprenorphine would be expected to financially impact primary care practices under each of four typical delivery approaches. Based on interviews with N = 20 primary care practices of varying sizes and types, we identified four distinct approaches for delivering office-based opioid treatment with buprenorphine. We then incorporated the operational details of each approach into a microsimulation model that sampled from national datasets on personnel, overhead, and claims to assess the cost and revenue implications of each approach for practice finances generally.