Costs of implementing a multi-site facilitation intervention to increase access to medication treatment for opioid use disorder

Carla C. Garcia, Mark Bounthavong, Adam J. Gordon, Allison M. Gustavson, Marie E. Kenny, Wendy Miller, Aryan Esmaeili, Princess E. Ackland, Barbara A. Clothier, Ann Bangerter, Siamak Noorbaloochi, Alex H.S. Harris, Hildi J. Hagedorn

Research output: Contribution to journalArticlepeer-review


Background: The United States has been grappling with the opioid epidemic, which has resulted in over 75,000 opioid-related deaths between April 2020 and 2021. Evidence-based pharmaceutical interventions (buprenorphine, methadone, and naltrexone) are available to reduce opioid-related overdoses and deaths. However, adoption of these medications for opioid use disorder has been stifled due to individual- and system-level barriers. External facilitation is an evidence-based implementation intervention that has been used to increase access to medication for opioid use disorder (MOUD), but the implementation costs of external facilitation have not been assessed. We sought to measure the facility-level direct costs of implementing an external facilitation intervention for MOUD to provide decision makers with estimates of the resources needed to implement this evidence-based program. Methods: We performed a cost analysis of the pre-implementation and implementation phases, including an itemization of external facilitation team and local site labor costs. We used labor estimates from the Bureau of Labor and Statistics, and sensitivity analyses were performed using labor estimates from the Veterans Health Administration (VHA) Financial Management System general ledger data. Results: The average total costs for implementing an external facilitation intervention for MOUD per site was $18,847 (SD 6717) and ranged between $11,320 and $31,592. This translates to approximately $48 per patient with OUD. Sites with more encounters and participants with higher salaries in attendance had higher costs. This was driven mostly by the labor involved in planning and implementation activities. The average total cost of the pre-implementation and implementation activities were $1031 and $17,816 per site, respectively. In the sensitivity analysis, costs for VHA were higher than BLS estimates likely due to higher wages. Conclusions: Implementing external facilitation to increase MOUD prescribing may be affordable depending on the payer’s budget constraints. Our study reported that there were variations in the time invested at each phase of implementation and the number and type of participants involved with implementing an external facilitation intervention. Participant composition played an important role in total implementation costs, and decision makers will need to identify the most efficient and optimal number of stakeholders to involve in their implementation plans.

Original languageEnglish (US)
Article number91
JournalImplementation Science Communications
Issue number1
StatePublished - Dec 2023

Bibliographical note

Funding Information:
This study was funded by the Veteran Administrations Health Services Research and Development Investigator Initiated Research Project #16–145. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2023, BioMed Central Ltd.


  • Cost analysis
  • Evidence-based practice
  • External facilitation
  • Implementation science
  • Medication for opioid use disorder

PubMed: MeSH publication types

  • Journal Article


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