Understanding the Costs of Using Implementation Facilitation to Implement Emergency Department-Initiated Buprenorphine
The costs captured in this study serve as a key reference to help healthcare systems adopt and expand strategies for administering buprenorphine in emergency rooms.
Buprenorphine, when prescribed in the emergency department (ED), increases the chances for treatment engagement and retention among patients with opioid use disorder (OUD). The patient uptake and clinical administration of ED-initiated buprenorphine for OUD, however, has been slow despite evidence of its effectiveness. Implementation facilitation (IF), a strategy that leverages external facilitators and a local champion to adopt new practices, is a cost-effective method for increasing ED-based initiation of buprenorphine for OUD, and successful linkage to community-based care.
Danielle Ryan, lead author and research manager at Weill Cornell Medicine, conducted a microcosting analysis alongside Project ED Health, a NIDA-funded clinical trials study, to understand the full costs of implementing and sustaining an ED-initiated buprenorphine program through IF. Published in the American Journal of Emergency Medicine, the study also offers a customizable budget impact tool to inform decision makers at prospective sites and elsewhere about the financial implications of investing in IF.
Necessary resources were identified and valued using an activity-based costing approach, then organized within the budget impact tool to generate cost estimates. Semi-structured interviews were conducted across four study sites and optimally timed to document each site’s activities and resource needs while limiting recall bias. The costs were analyzed according to the three main phases of the IF strategy: pre-implementation, IF, and sustainment.
Key Findings
- The cost of a 12-month pre-implementation phase averaged $27,753 per site.
- The cost of a 6-month IF phase, followed by a 12-month IF evaluation period, averaged $53,558 per site.
- The annual cost to sustain the program averaged $226,822 per site.
- Assuming each site identified and saw a monthly estimate of 195 patients with OUD, the average per-patient was $115.
The start-up and maintenance costs captured in this study serve as a key reference to help healthcare systems adopt and expand strategies for administering buprenorphine in the ED. The resulting estimates in this study were comparable to the previously-documented expenses of a California-based program that facilitated ED-based buprenorphine, linkage to community care, and harm reduction strategies. The authors suggest that future research evaluating the cost-effectiveness of Project ED Health compared to alternative programs promoting low-threshold medication for OUD, could help maximize access to such care by ensuring resources are used efficiently.
The study, “Microcosting implementation facilitation for emergency department-initiated buprenorphine for untreated opioid use disorder,” was published online in the American Journal of Emergency Medicine, on August 12, 2025. The study also features senior author and CHERISH Co-director Sean Murphy, CHERISH Methodology Core Co-director Ali Jalali, and CHERISH Research Affiliate Thanh Lu.
The budget impact tool used in this study is available for download on our resources page. To learn how to use the tool, request guidance through the CHERISH Consultation Service.