Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    Mental illness is increasingly common among young people but many are not receiving the treatment that they need. This Data Insights explores current trends in youth mental health and opportunities to improve outcomes.

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  • Grants

    NIHCM Foundation has awarded 14 grants for health care journalism including investigative reporting and educational opportunities for reporters.

    Press Release All Journalism Grantees
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • Grants

    NIHCM Foundation has awarded over $500,000 in grants to support nine investigator-initiated research studies.

    Press Release All Research Grantees
  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

Shorter Initial Prescriptions for Opioids: What are the Health and Economic Benefits?

Why This Study Is Important

Opioid-naïve patients are more likely to become addicted to opioids if their initial prescription is for a longer duration, and easy access to leftover medication from friends and family members is a common route to opioid abuse for others who were not prescribed the medication. CDC prescribing guidelines for acute pain emphasize the importance of prescribing the minimum effective dose for a period no longer than the expected duration of pain. Despite this emphasis, there is little evidence on the impact of policy changes intended to limit initial access to opioids. This study investigates the patient welfare and economic impacts of moving to shorter initial opioid prescriptions.

What This Study Found

  • Moving 10,000 patients from an initial opioid prescription that supplies more than seven days of medicine to one providing three or fewer days would increase patient welfare by the equivalence of 3,600 to 4,500 opioid free months over two years, depending on the utility values assumed for different opioid states.
  • This same change would generate more than $3 million in direct employer savings for these patients over two years.
  • Programs to change prescribing behavior to favor shorter initial prescriptions were estimated to be cost effective across a range of program implementation costs. Even at a per-person program cost of $1,150, the incremental cost-effectiveness ratio is well below commonly-used benchmarks for deeming an intervention to be cost effective.

What These Findings Mean

These simulations show, for the first time, that reducing the duration of initial opioid prescriptions can significantly improve patient welfare and save money for employers. The gains described here would likely have been much higher if estimated for the older, sicker general population and if the model had accounted for additional adverse effects of chronic opioid use that impose high costs on patients and society, such as drug-associated criminality, suicides and overdoses. Despite these conservative estimates, the modeling shows that initiatives to encourage physicians to use shorter initial opioid prescriptions can be cost effective even if program implementation costs are relatively high. Exploring the effectiveness of potential strategies to modify prescribing behavior is a promising next step in tackling prescription opioid abuse.

More About This Study

Propensity score matching was applied to data from a nationwide sample to construct two large cohorts of service members having at least one opioid prescription between 2011 and 2014. The cohorts differed only in whether the initial prescription was for a long or short duration (more than seven days of opioids vs. three days or less). Patients were followed for up to two years to determine changes between six health states each month: no opioid prescriptions; short, medium, or long periods of opioid supply; opioid prescriptions in any three of the four prior months; or discharged from service. Cohort trajectories were traced over time using a Markov model, and the economic burden to the employer (Army) and patient welfare were tallied for each trajectory. Employer costs reflected medical care and lost productivity and replacement costs when soldiers could not fulfill their duties or were discharged. Patient welfare estimates were based on quality adjusted life years (QALYs), with periods of opioid use assigned lower utility values. A range of model parameters were used to simulate the welfare gains and cost savings of moving 10,000 patients from long- to short-duration initial prescriptions. Program cost effectiveness was gauged by the net program implementation costs per QALY gained.

Full Citation

Bjarnadóttir MV, Anderson DR, Prasad K, Agarwal R and Nelson DA. “The Value of Shorter Initial Opioid Prescriptions: A Simulation Evaluation.” PharmacoEconomics, 38(1):109-19. January 2020. 

This Research Insights highlights a study finding that reducing initial opioids prescriptions from seven days worth of opioids to three or fewer days had positive health and economic benefits.

Events

February 24, 2020
Teen-Mental-Health-webinar-graphic

This webinar explored cross-sector strategies to prevent teen substance and suicide, as well as the role of school-based health services in providing behavioral health care.

January 27, 2020
SDOH-webinar-graphic-012720

This webinar explored public and private sector efforts to improve health outcomes by addressing social determinants of health.

In the News

February 2020
Population Health Spotlight
newsletter-alcohol-deaths-v2

Grants

Journalism GrantsJournalism Grant Program

NIHCM has announced its 2019 journalism grantees. We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Investigator-Initiated Research Grant Program

NIHCM has announced its 2019 research grantees. We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

The 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

We are no longer accepting entries for this year's awards cycle. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

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