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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 28 Research Studies DisplayedEddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
AHRQ-funded; HS027389.
Citation: Toseef MU, Durfee J, Podewils LJ .
Total cost of care associated with opioid use disorder treatment.
Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Presskreischer R, Steinglass JE, Anderson KE
Eating disorders in the U.S. Medicare population.
This cross-sectional study explored the prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. A representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records was used. The sample included almost 12 million Medicare enrollees of whom 0.15% had an eating disorder diagnosis. A greater proportion of individuals diagnosed with an eating disorder diagnosis were female, under age 65, and dually eligible for Medicaid due to disability or low-income qualification than those without a diagnosis. Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias, arthritis, and thyroid conditions. Spending was $29,456 for enrollees with eating disorders compared to $7,418 without.
AHRQ-funded; HS000029.
Citation: Presskreischer R, Steinglass JE, Anderson KE .
Eating disorders in the U.S. Medicare population.
Int J Eat Disord 2022 Mar;55(3):362-71. doi: 10.1002/eat.23676..
Keywords: Behavioral Health, Medicare, Healthcare Costs
McClellan C, Moriya A, Simon K
AHRQ Author: McClellan C Moriya A
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
This paper provides national estimates of financial costs faced by the population receiving retail medications for opioid use disorders (MOUD). Using MEPS data, findings showed that patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage was associated with reduced annual out-of-pocket MOUD expenditures. Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with opioid use disorders.
AHRQ-authored.
Citation: McClellan C, Moriya A, Simon K .
Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
J Subst Abuse Treat 2022 Jan;132:108645. doi: 10.1016/j.jsat.2021.108645..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Substance Abuse, Behavioral Health, Healthcare Costs, Medication
Zuvekas SH, Grosse SD, Lavelle TA
AHRQ Author: Zuvekas SH
Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015.
Published healthcare cost estimates for children with autism spectrum disorder (ASD) vary widely. One possible contributor is different methods of case ascertainment. In this study, autism spectrum disorder (ASD) case status was determined using two sources of parent reports among 45,944 children ages 3-17 years in the Medical Expenditure Panel Survey (MEPS) linked to the National Health Interview Survey (NHIS) Sample Child Core questionnaire. In this paper, the investigators describe their process and conclusions.
AHRQ-authored.
Citation: Zuvekas SH, Grosse SD, Lavelle TA .
Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015.
J Autism Dev Disord 2021 Aug;51(8):2950-58. doi: 10.1007/s10803-020-04704-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Autism, Healthcare Costs, Behavioral Health
Friedman S, Xu H, Azocar F
Carve-out plan financial requirements associated with national behavioral health parity.
The authors examined changes in carve-out financial requirements following the Mental Health Parity and Addiction Equity Act (MHPAEA). They found that the MHPAEA was associated with increased generosity in most observed financial requirements, but increased use of deductibles may have reduced generosity for some patients.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Azocar F .
Carve-out plan financial requirements associated with national behavioral health parity.
Health Serv Res 2020 Dec;55(6):924-31. doi: 10.1111/1475-6773.13542..
Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Access to Care, Policy
Yeung K, Richards J, Goemer E
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
The purpose of this study was to describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018). The investigators concluded that when spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests).
AHRQ-funded; HS023173.
Citation: Yeung K, Richards J, Goemer E .
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
Health Serv Res 2020 Dec;55(6):913-23. doi: 10.1111/1475-6773.13592..
Keywords: Healthcare Costs, Evidence-Based Practice, Implementation, Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Fung V, Price M, Nierenberg AA
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
This study looked at outcomes from reducing behavioral health care Medicare coinsurance from 50% to 20% from 2009 to 2013. The sample of patients looked at included some diagnosed with SMI (serious mental illness) including schizophrenia, bipolar, or major depressive disorder). Data analysis was performed on 793,275 beneficiaries with SMI in 2008 and compared them with costs in 2013. The mean adjusted out-of-pocket costs for outpatient behavioral care decreased from $132 annually to $64, but the number of visits only increased slightly. No association was found between cost-sharing reductions and changes in behavioral health care visits.
AHRQ-funded; HS024725.
Citation: Fung V, Price M, Nierenberg AA .
Assessment of behavioral health services use among low-income Medicare beneficiaries after reductions in coinsurance fees.
JAMA Netw Open 2020 Oct;3(10):e2019854. doi: 10.1001/jamanetworkopen.2020.19854..
Keywords: Medicare, Health Insurance, Depression, Behavioral Health, Low-Income, Healthcare Costs, Healthcare Utilization
Hodgkin D, Moscarelli M, Rupp A
AHRQ Author: Zuvekas SH
Mental health economics: bridging research, practice and policy.
The authors discuss the past and current work of the World Psychiatric Association Section on Mental Health Economics. They conclude with stating that The Section strives for excellence in mental health economics research and education to promote the mission and fulfill the goals of the World Psychiatric Association.
Citation: Hodgkin D, Moscarelli M, Rupp A .
Mental health economics: bridging research, practice and policy.
World Psychiatry 2020 Jun;19(2):258-59. doi: 10.1002/wps.20753..
Keywords: Behavioral Health, Healthcare Costs, Health Services Research (HSR), Policy
Cook BL, Flores M, Zuvekas SH
AHRQ Author: Zuvekas SH
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
This study examined the impact of Medicare’s mental health cost-sharing parity on use of mental health care services, which was phased in from 2010 to 2014. The authors assessed whether the reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. They compared people with Medicare and private insurance before and after implementation. Medicare beneficiaries’ use of psychotropic medication increased after implementation but there was not a detectable change in visits.
AHRQ-authored.
Citation: Cook BL, Flores M, Zuvekas SH .
The impact Of Medicare's mental health cost-sharing parity on use of mental health care services.
Health Aff 2020 May;39(5):819-27. doi: 10.1377/hlthaff.2019.01008..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicare, Behavioral Health, Healthcare Costs, Policy, Health Insurance, Healthcare Utilization, Access to Care
Grafova IB, Monheit AC, Kumar R
How do changes in income, employment and health insurance affect family mental health spending?
This study used eight two-year panels from the MEPS data for 2004 to 2012 to examine the effect of economic shocks on mental health spending by families with children. Researchers wanted to determine whether the greatest impact on mental health spending comes from income, employment, or health insurance shocks. They used two-part expenditure models to estimate that employment losses are positively related to an increase in total family mental health expenditures. But no link was found between economic shocks and mental health spending on fathers.
AHRQ-funded; HS024053.
Citation: Grafova IB, Monheit AC, Kumar R .
How do changes in income, employment and health insurance affect family mental health spending?
Rev Econ Househ 2020 Mar;18(1:239-63. doi: 10.1007/s11150-018-9436-y.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Behavioral Health, Social Determinants of Health, Health Insurance
Adams DR, Williams NJ, Becker-Haimes EM
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
In this study, the investigators prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. The investigators expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. They found that, controlling for covariates, financial strain predicted therapist turnover but not for therapists who participated in an EBP training initiative.
AHRQ-funded; HS000084.
Citation: Adams DR, Williams NJ, Becker-Haimes EM .
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
Adm Policy Ment Health 2019 Nov;46(6):713-23. doi: 10.1007/s10488-019-00949-8..
Keywords: Healthcare Costs, Evidence-Based Practice, Behavioral Health, Provider, Provider: Clinician, Training, Workforce
Nasol E, Lindly OJ, Chavez AE
Unmet need and financial impact disparities for US children with ADHD.
The 5.1million US children with attention-deficit/hyperactivity disorder (ADHD) have pronounced needs in education, occupational and speech therapy, and medical and behavioral treatments. Given known associations of ADHD diagnosis with race/ethnicity and parent education, this study aimed to assess how measures of socioeconomic status correlate with both adverse family financial impact of ADHD and disparities in unmet treatment need for ADHD.
AHRQ-funded; HS000063.
Citation: Nasol E, Lindly OJ, Chavez AE .
Unmet need and financial impact disparities for US children with ADHD.
Acad Pediatr 2019 Apr;19(3):315-24. doi: 10.1016/j.acap.2018.09.001..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Costs, Social Determinants of Health
Patel KR, Singam V, Rastogi S
Association of vitiligo with hospitalization for mental health disorders in US adults.
The goal of this study was to examine the relationship between vitiligo and mental-health hospitalizations in the US using data from the National Inpatient Sample. Prevalence of hospitalization for mental-health disorders, length of stay (LOS), and cost of care were examined for patients with vitiligo in comparison with those without vitiligo. Hospitalization for mental-health disorders occurred more commonly in those with vitiligo. Vitiligo patients who were hospitalized with any mental-health disorder had higher LOS as well as cost of inpatient care.
AHRQ-funded; HS023011.
Citation: Patel KR, Singam V, Rastogi S .
Association of vitiligo with hospitalization for mental health disorders in US adults.
J Eur Acad Dermatol Venereol 2019 Jan;33(1):191-97. doi: 10.1111/jdv.15255..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Hospitalization, Behavioral Health, Skin Conditions
Annapureddy A, Valero-Elizondo J, Khera R
Association between financial burden, quality of life, and mental health among those with atherosclerotic cardiovascular disease in the United States.
Currently, there is little information about the relationship between the financial burden of healthcare for patients with atherosclerotic cardiovascular disease (ASCVD) and their health-related quality of life (HRQoL), well-being, and psychological health. Accordingly, the authors of this study, determined the relationship between healthcare financial burden and patient-reported HRQoL, self-perception of health, psychological distress, and risk of depression in a nationally representative US adult population with established ASCVD.
AHRQ-funded; HS023000.
Citation: Annapureddy A, Valero-Elizondo J, Khera R .
Association between financial burden, quality of life, and mental health among those with atherosclerotic cardiovascular disease in the United States.
Circ Cardiovasc Qual Outcomes 2018 Nov;11(11):e005180. doi: 10.1161/circoutcomes.118.005180..
Keywords: Cardiovascular Conditions, Healthcare Costs, Behavioral Health, Quality of Life
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Joyce NR, Huskamp HA, Hadland SE
The alternative quality contract: impact on service use and spending for children with ADHD.
The authors used Blue Cross-Blue Shield of Massachusetts (BCBSMA) claims for 2006-2011 to compare youths enrolled in provider organizations participating in the alternative quality contract (AQC) with those not participating. They found that the AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Further, spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.
AHRQ-funded; HS022998.
Citation: Joyce NR, Huskamp HA, Hadland SE .
The alternative quality contract: impact on service use and spending for children with ADHD.
Psychiatr Serv 2017 Dec;68(12):1210-12. doi: 10.1176/appi.ps.201700143.
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Keywords: Children/Adolescents, Behavioral Health, Payment, Quality of Care, Healthcare Costs
Friedman S, Xu H, Harwood JM
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
The purpose of this study was to determine whether Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with increased behavioral health expenditures and utilization among a population with substance use disorder (SUD) diagnoses. The investigators found that MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization.
AHRQ-funded; HS024866.
Citation: Friedman S, Xu H, Harwood JM .
The Mental Health Parity and Addiction Equity Act evaluation study: impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.
J Subst Abuse Treat 2017 Sep;80:67-78. doi: 10.1016/j.jsat.2017.06.006..
Keywords: Behavioral Health, Healthcare Costs, Healthcare Utilization, Health Insurance, Policy, Health Services Research (HSR), Substance Abuse
Berry JG, Ash AS, Cohen E
Contributions of children with multiple chronic conditions to pediatric hospitalizations in the United States: a retrospective cohort analysis.
Researchers assessed how much of US pediatric inpatient care is used by children with multiple chronic conditions (CMCC) and which chronic conditions are the key drivers of hospital use. CMCC accounted for over one-fourth of acute-care hospitalizations and one-half of all hospital dollars for US pediatric care in 2012. Substantial CMCC hospital resource use involves children with mental health-related conditions.
AHRQ-funded; HS023092.
Citation: Berry JG, Ash AS, Cohen E .
Contributions of children with multiple chronic conditions to pediatric hospitalizations in the United States: a retrospective cohort analysis.
Hosp Pediatr 2017 Jul;7(7):365-72. doi: 10.1542/hpeds.2016-0179.
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Keywords: Children/Adolescents, Chronic Conditions, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Behavioral Health
Kass AE, Balantekin KN, Fitzsimmons-Craft EE
The economic case for digital interventions for eating disorders among United States college students.
This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses.
AHRQ-funded; HS000078.
Citation: Kass AE, Balantekin KN, Fitzsimmons-Craft EE .
The economic case for digital interventions for eating disorders among United States college students.
Int J Eat Disord 2017 Mar;50(3):250-58. doi: 10.1002/eat.22680.
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Keywords: Behavioral Health, Healthcare Delivery, Healthcare Costs, Prevention, Primary Care: Models of Care, Telehealth, Young Adults, Web-Based
Ali MM, Chen J, Mutter R
AHRQ Author: Novak P
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
The authors analyzed out-of-pocket spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. They found that the extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
AHRQ-authored.
Citation: Ali MM, Chen J, Mutter R .
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
Psychiatr Serv 2016 Sep;67(9):977-82. doi: 10.1176/appi.ps.201500346.
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Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Young Adults
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
AHRQ-funded; HS018657.
Citation: Zhang Y, Talisa V, Baik SH .
Part D plan switching among Medicare beneficiaries with schizophrenia.
Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
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Keywords: Healthcare Costs, Medicare, Behavioral Health
Predmore ZS, Mattke S, Horvitz-Lennon M
Improving antipsychotic adherence among patients with schizophrenia: savings for states.
The authors presented findings of an analysis conducted to quantify the potential net savings to state budgets from interventions to improve adherence to antipsychotic drugs among patients with schizophrenia. Their financial model estimated an annual cost of $21.4 billion (in 2013 dollars) to Medicaid programs and other state agencies for people with schizophrenia. They concluded that better adherence could yield annual net savings of $3.28 billion to states and recommended that states consider interventions shown to increase medication adherence in this patient group.
AHRQ-funded; HS000029.
Citation: Predmore ZS, Mattke S, Horvitz-Lennon M .
Improving antipsychotic adherence among patients with schizophrenia: savings for states.
Psychiatr Serv 2015 Apr;66(4):343-5. doi: 10.1176/appi.ps.201400506.
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Keywords: Healthcare Costs, Medication, Behavioral Health, Patient Adherence/Compliance
Cook BL, Liu Z, Lessios AS
The costs and benefits of reducing racial-ethnic disparities in mental health care.
The investigators examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. They found that, for blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial, as much as $1 billion nationwide, suggesting that financial and equity considerations can be aligned when planning disparity reduction programs.
AHRQ-funded; HS021486.
Citation: Cook BL, Liu Z, Lessios AS .
The costs and benefits of reducing racial-ethnic disparities in mental health care.
Psychiatr Serv 2015 Apr;66(4):389-96. doi: 10.1176/appi.ps.201400070.
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Keywords: Disparities, Healthcare Costs, Racial and Ethnic Minorities, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Zhang Y, Baik SH, Newhouse JP
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
The investigators simulated Medicare Part D savings from replacing random assignment with an "intelligent assignment" algorithm that would assign beneficiaries to the least expensive plan in 2010 based on their drug usage in the previous year. They found that intelligent assignment could have saved about $150 million for Medicare and beneficiaries with schizophrenia combined in 2010.
AHRQ-funded; HS018657.
Citation: Zhang Y, Baik SH, Newhouse JP .
Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings.
Health Aff 2015 Mar;34(3):455-60. doi: 10.1377/hlthaff.2014.1227.
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Keywords: Healthcare Costs, Medicare, Medication, Behavioral Health