Table 4.

Primary and Secondary Outcomes in the First Year of Buprenorphine Treatment Implementation (Year 1) and in Each Subsequent Year (After Year 1 for Each of 10 Years) Across 4 Approaches for Office-Based Opioid Treatment With Buprenorphine, and Among the Different Simulated Practice Types

Gross Revenue $ (95% CI)Opportunity Costs $ (95% CI)New Personnel and Overhead Costs $ (95% CI)Net Revenue $ (95% CI)
Year 1
FQHC
   Physician-led41,769 (17,408-73,092)6,395 (2,517-12,393)6,514 (3,508-10,647)28,859 (9,247-54,294)
   Nurse-led35,857 (15,013-63,183)3,240 (1,438-5,964)9,746 (4,929-16,344)22,870 (6,258-45,087)
   Shared41,942 (17,390-73,618)4,081 (1,716-7,573)9,193 (4,700-15,475)28,668 (9,026-55,032)
   Solo29,656 (12,298-52,300)7,880 (3,374-14,569)021,776 (7,964-40,045)
Urban
   Physician-led59,641 (27,589-104,484)7,508 (3,471-13,481)6,364 (3,632-9,832)45,769 (17,812-85,568)
   Nurse-led54,576 (24,983-96,817)3,996 (2,014-6,793)8,974 (5,062-14,234)41,606 (15,280-79,472)
   Shared59,046 (27,545-103,358)4,931 (2,429-8,497)8,521 (4,810-13,509)45,593 (17,826-85,198)
   Solo35,112 (16,659-61,275)9,552 (4,779-16,355)025,560 (10,299-47,435)
Rural
   Physician-led85,035 (34,078-157,980)10,027 (4,086-19,218)5,642 (2,966-9,378)69,366 (24,814-134,442)
   Nurse-led77,939 (30,947-146,822)5,041 (2,317-9,133)8,575 (4,285-14,885)64,323 (22,021-126,578)
   Shared84,142 (34,404-155,899)6,368 (2,838-11,789)8,092 (4,091-14,110)69,682 (24,761-134,089)
   Solo49,895 (20,589-92,754)12,299 (5,549-22,553)037,596 (13,617-73,853)
Other
   Physician-led45,677 (10,184-97,483)5,976 (2,115-12,076)6,302 (3,338-10,049)33,399 (2,990-79,070)
   Nurse-led42,193 (9,386-91,756)3,399 (1,506-6,194)8,296 (4,168-14,212)30,499 (2,065-75,037)
   Shared45,116 (10,211-96,573)4,078 (1,696-7,662)7,929 (3,949-13,301)33,108 (2,651-79,258)
   Solo26,085 (5,935-55,506)7,944 (3,303-14,887)018,141 (1,702-42,051)
Year 2+
FQHC
   Physician-led41,769 (17,408-73,092)5,519 (1,779-11,327)3,234 (1,159-6,404)33,016 (13,567-58,589)
   Nurse-led35,857 (15,013-63,183)2,357 (749-4,925)6,455 (2,345-12,448)27,044 (10,820-49,205)
   Shared41,942 (17,390-73,618)3,204 (1,024-6,509)5,903 (2,108-11,579)32,835 (13,388-59,298)
   Solo29,656 (12,298-52,300)6,119 (1,979-12,547)023,538 (9,683-41,899)
Urban
   Physician-led59,641 (27,589-104,484)6,153 (2,333-12,012)2,660 (1,145-5,016)50,828 (22,860-90,418)
   Nurse-led54,576 (24,983-96,817)2,631 (977-5,113)5,257 (2,237-9,696)46,688 (20,264-84,319)
   Shared59,046 (27,545-103,358)3,575 (1,358-6,884)4,806 (2,053-8,917)50,664 (23,090-90,283)
   Solo35,112 (16,659-61,275)6,829 (2,576-13,015)028,283 (12,938-50,689)
Rural
   Physician-led85,035 (34,078-157,980)8,716 (2,901-17,783)3,671 (1,337-7,339)72,649 (28,513-137,390)
   Nurse-led77,939 (30,947-146,822)3,721 (1,228-7,608)5,786 (2,116-11,413)68,432 (26,186-130,898)
   Shared84,142 (34,404-155,899)5,058 (1,703-10,353)5,305 (1,945-10,692)73,779 (29,224-138,600)
   Solo49,895 (20,589-92,754)9,664 (3,263-19,592)040,231 (16,037-76,726)
Other
   Physician-led45,677 (10,184-97,483)4,512 (1,107-7,623)2,080 (427-4,650)39,085 (8,650-85,210)
   Nurse-led42,193 (9,386-91,756)1,923 (371-4,339)4,058 (860-9,042)36,212 (7,785-80,774)
   Shared45,116 (10,211-96,573)2,615 (503-5,939)3,695 (813-8,171)38,806 (8,649-84,639)
   Solo26,085 (5,935-55,506)5,000 (983-11,455)021,086 (4,697-45,406)
  • FQHC = federally qualified health center.

  • Note: The 4 approaches were (1) buprenorphine therapy via prescriber-led visits, which involved prescribers leading routine visits for medication management with a nurse care manager providing program coordination, intake visits, telephone outreach, and induction management, (2) buprenorphine therapy via nurse-led visits, which involved a nurse care manager leading patient visits and care management and prescribers meeting the patient every 3 months after induction for medication management, (3) buprenorphine therapy via shared medical appointments, which involved the prescribers leading a weekly group visit (including medication titration) in concert with a behaviorist and nurse care manager, and (4) buprenorphine therapy via a solo prescriber, which involved the physician prescribing buprenorphine without major structural support from auxiliary staff. The 4 practice types were (1) FQHCs and FQHC look-alikes, (2) non-FQHC practices in high-poverty urban areas by Census definition (>20% of households within the ZIP Code having an income below the federal poverty threshold after adjustment for household size), (3) non-FQHC practices in high-poverty rural areas by Census definition (>20% of households within the ZIP Code having an income below the federal poverty threshold after adjustment for household size), and (4) practices outside of high-poverty areas.