Center for Health Economics of Treatment for Substance Users Is Established at Weill Cornell Medical College

The high costs of treating the more than 7 million people with a substance use disorder may be daunting to public and private payers. The costs of not treating them may be even higher, especially if you consider the costs of failing to screen for and treat HIV and hepatitis C in this population. Sorting out the complex economics of treating substance use disorder is the goal of a new center funded by a $5.8 million grant from the National Institute on Drug Abuse.

Bruce R. Schackman, Ph.D., professor of healthcare policy and research and the Saul P. Steinberg Distinguished Professor of Psychiatry and Public Health at Weill Cornell Medical College will lead the cross-institutional Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (“CHERISH”). The Center will serve as a national resource for substance use health economics research by developing and disseminating economic evidence that informs substance use treatment policy and hepatitis C and HIV care for substance users.

“By furthering scientific collaboration among researchers, administering pilot grants, and conducting training activities and outreach to clinical and policy decisions makers, CHERISH will increase the impact of substance use economic research, especially by addressing the needs of integrated healthcare system providers and payers” says Dr. Schackman, who serves as the Center’s director. “This new funding allows us to create an infrastructure that will enhance existing research projects, promote state-of-the art economic research methods, and improve the ability of substance use economic researchers to communicate with decision makers and address changes in today’s healthcare system,” Dr. Schackman continues.

“As a result of transformations within the healthcare industry, providers and insurers are now considering the totality of costs and benefits of healthcare, instead of just the costs and benefits of individual service delivery silos,” says Rainu Kaushal, M.D., M.P.H., the Frances and John L. Loeb Professor of Medical Informatics and chair of the Department of Healthcare Policy and Research at Weill Cornell, where the Center will be headquartered. “Dr. Schackman and his multi-institutional team are uniquely qualified to address the economic opportunities and challenges of integrating substance use treatment into these new systems of care.”

In 2013, an estimated 7.6 million persons aged 12 or older needed treatment for misuse of illicit drugs, but only 1.5 million of these individuals received specialty treatment. Among those who felt they needed treatment, the most commonly reported reason for not receiving it was lack of insurance coverage and inability to afford the cost. From 2014 to 2020, spending on treatment for substance use disorders in the U.S. is expected to grow from $31.3 billion to $42.1 billion, growth that will be driven by the expansion of insurance coverage and the integration of substance use treatment into the broader spectrum of health services.

CHERISH, which is being launched to address the economic implications of fulfilling the substance use and medical treatment needs of substance users, is a collaboration among researchers at Weill Cornell Medical College, Boston Medical Center, the University of Pennsylvania, and the University of Miami.

“Health insurance expansion presents new opportunities for integrated care of substance users, such as mandatory coverage for hepatitis C and HIV screening without patient co-payments” says Benjamin P. Linas, M.D., M.P.H., Director of HIV Epidemiology and Outcomes Research Unit at Boston Medical Center and assistant professor at Boston University School of Medicine, who will serve as the HCV and HIV Core Director for CHERISH. “However, the budget impact on payers of expensive new treatments for medical conditions associated with substance use, especially for hepatitis C, raise important questions that need to be answered with independent evidence-based economic research.”

“The recent HIV outbreak among substance users in rural Indiana has alerted many policy makers to the importance of expanding substance use treatment services, in order to avoid costly medical complications and improve the lives of individuals who currently lack access to treatment” says Zachary F. Meisel, M.D., M.P.H., M.S., a senior fellow at the Leonard Davis Institute of Health Economics (LDI) and an assistant professor of emergency medicine at the University of Pennsylvania, who will serve as the Policy and Dissemination Core Director for CHERISH.

Daniel Polsky, Ph.D., an eminent health economist who has led several studies on substance use economics, will serve as co-Director of the CHERISH Dissemination and Policy Core. “We will bring the full resources of LDI to translate, disseminate, and enhance the relevance of substance use health economic research results to clinical and policy stakeholders” says Dr. Polsky, who is Executive Director of LDI, Robert D Eilers Professor of Healthcare Management at the Wharton School, and professor of medicine at the University of Pennsylvania.

Additional CHERISH Core Directors and co-Directors include Brandon Aden, M.D., M.P.H., assistant professor of medicine and assistant professor of healthcare policy and research at Weill Cornell Medical College; Jeffrey H. Samet M.D., M.P.H., professor of medicine and professor of public health at Boston University Schools of Medicine and Public Health; and Kathryn E. McCollister, Ph.D., associate professor in the Department of Public Health Sciences at the University of Miami Miller School of Medicine.

Dr. Schackman’s recent research includes economic evaluations of HIV and hepatitis C testing and treatment in substance use treatment settings, and the cost and outcomes of integrating substance use and medical treatments. His research related to treatment of infectious diseases and substance use has included economic evaluations of the comparative effectiveness of health interventions conducted alongside clinical trials and cohort studies, cost-effectiveness simulation modeling, and implementation science research regarding budgetary and operational barriers to implementing evidence-based medical interventions. His research and leadership in the field have laid the groundwork for the newly established Center.