Estimated Hospital Cost Reduction Following Implementation of Hospital-dispensed Discharge Methadone.

Abstract

US regulatory changes now allow practitioners to dispense up to a 3-day supply of methadone from the inpatient pharmacy at hospital dishcarge at one time. We characterized outcomes related to hospital-dispensed discharge methadone, including saved hospital days and reductions in hospital costs. We included all hospitalizations involving hospital-dispensed discharge methadone for opioid use disorder. We identified the mean number of discharge methadone doses ordered per hospitalization to determine a reduction in length of hospital stay, where 1 discharge methadone dose equals 1 hospital day saved. We used 2 approaches: a health care cost accounting approach that uses patient-level health care cost data and an adjusted inpatient day metric that uses data from the hospital's aggregated operating costs to estimate hospital cost reductions related to discharge methadone. Between April 2023 and July 2025, 175 hospitalizations involving 374 orders for discharge methadone reduced length of stay by 357 days after accounting for split doses, that is, twice daily doses for pain, pregnancy, or rapid methadone metabolism. The mean number of discharge methadone doses per hospitalization was 2.1. Using a health care cost accounting approach, the median cost reduction was $850/d with a total cost reduction of $304,450 over the study period. Using an adjusted inpatient day estimate, the total cost reduction was $3953/d with a total cost reduction of $1,411,221 over the study period. Hospital-dispensed discharge methadone reduced costs by facilitating hospital discharges. Cost savings related to reduced emergency department overcrowding or avoidance of nosocomial infections were not captured and should be considered when implementing discharge methadone processes.