Continuing care approach reduces overall health costs for patients with SUD

For patients with substance use disorders (SUD), a continuing care approach like that used for other chronic diseases reduces long-term health care costs, reports a study in the June issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In addition to helping patients remain abstinent from drugs and alcohol, the nine-year follow-up study suggests that continuing care reduces overall costs—mainly by reducing hospital admissions. Led by Sujaya Parthasarathy, PhD, of Kaiser Permanente Northern California, Oakland, the researchers conclude, "[O]ur findings reinforce the importance of access to health care and development of interventions that optimize patients receiving those services and that may reduce costs to health systems."

Continuing Care Reduces Overall Health Costs for SUD Patients
The researchers analyzed long-term health care costs in patients first treated for SUD between 1994 and 1998. After initial treatment, some patients were managed according to a continuing care approach—modeled after that used for other "chronic, relapsing" diseases, such as diabetes or asthma.

In this approach, patients made regular visits to their primary care doctor. If a standard assessment showed any drug or alcohol use, the patient returned to SUD treatment. If the same assessment revealed serious symptoms of mental health disorders (such as depression or anxiety), the patient was referred for psychiatric services. A previous study reported that SUD patients receiving continuing care were twice as likely to stay in remission—including abstinence from drugs and alcohol—as those receiving standard care.

At nine years' follow-up, overall health care costs were significantly lower for SUD patients receiving continuing care. Average monthly costs were about $221 for SUD patients receiving all components of continuing care, compared to $294 per month for other SUD patients.

Savings from Reduced Hospital Admissions and ER Visits
The difference mainly reflected reduced hospital costs—after adjustment for other factors, the hospital admission rate was nearly three times higher for SUD patients who did not receive continuing care. Patients in continuing care also had lower rates and costs of ER visits.

With continuing care, hospital costs were similar to those for non-SUD patients of similar age and sex. The savings in hospital costs offset higher costs for primary care visits and psychiatric services in the continuing care group.

While the study can't prove a causal link, the results suggest that continuing care for SUD leads to lower long-term health costs. The researchers write, "It is reasonable to assume that if regular contact with the health care system continues over time, as with other chronic diseases, critical events leading to ER or hospital events might be pre-empted, and relapsing patients identified and persuaded to readmit to treatment earlier."

The study also highlights the need for increased efforts to put SUD patients in touch with needed services—only about half of patients made regular primary care visits, while less than 20 percent received all three components of continuing care. "[A]n important lesson for health policy is to promote strategies for engaging SUD patients in treatment," according to Dr Parthasarathy and co-authors. "SUD treatment may also be a good place to teach patients to use health services effectively and appropriately."