JAMA Netw Open
Hospital addiction consults pay off in opioid use disorder
Clinical Takeaway: Hospital-based addiction consult services may be a practical, affordable way to start opioid use disorder treatment during admission.
Hospitalizations remain a missed opportunity in opioid use disorder care: patients are admitted frequently, but few leave on FDA-approved medication or with reliable follow-up. This economic evaluation tested whether a structured inpatient consult service is worth the investment compared with care left to the primary team's discretion.
The intervention, called the Substance Use Treatment and Recovery Team (START), pairs an addiction medicine specialist with a care manager. Together they assess hospitalized patients with opioid use disorder, initiate FDA-approved medication when appropriate, and coordinate discharge planning with linkage to outpatient treatment and follow-up calls for one month.
Per-patient implementation cost for START was $640, with personnel time accounting for $602 and training and onboarding the remainder. Compared with usual care, START produced an incremental cost of $162 and a gain of 0.0103 quality-adjusted life-years per patient, yielding an incremental cost-effectiveness ratio of $15,750 per QALY gained from a health sector perspective.
In a scenario assuming higher post-discharge medication initiation among START patients, which is supported by trial data, the intervention became cost-saving. The strongest drivers of cost-effectiveness were health care expenditures in the untreated state and the intervention's effect on medication initiation; implementation cost was among the least influential parameters.
The analysis drew on a randomized trial of 325 hospitalized adults with probable opioid use disorder at three academic medical centers between 2021 and 2023. Median age was 41 and 66% were male.
For hospital decision-makers, the practical implication is that roughly half of START's per-patient cost reflects billable services by the addiction medicine specialist, easing the budget impact of adoption. The authors suggest that value-based payment models could further accelerate uptake.
"START was a cost-effective approach for addressing opioid use disorder in the inpatient setting by increasing the initiation of medication for opioid use disorder and linkage to opioid use disorder-focused care after discharge," the authors concluded.
Source: Okunogbe A. JAMA Netw Open. 2026 May 7. Cost-Effectiveness of the START Hospital Addiction Consultation Service for Opioid Use Disorder Treatment