Investing in interventions to prevent opioid use disorder in adolescents and young adults: Start-up costs from NIDA’s HEAL prevention initiative

The purpose of this study was to estimate the costs of starting up diverse interventions for preventing opioid misuse in young people aged 15 to 30. Interventions were to be delivered in the context of research trials funded under the National Institutes of Health HEAL (Helping to End Addiction Long-term®) Prevention Initiative. Start-up activities were conducted in systems and settings across the United States from 2019 to 2023. Start-up costs were estimated using activity-based costing from a provider perspective and common methods and data collection procedures across projects (n = 8). Descriptive statistics were used to understand the magnitude of and variability in start-up costs, cost drivers, and staff time. Factors explaining variability were identified from project activity descriptions. Start-up activities cost $37,541 on average, and $33,492 at the median (2020 USD). Labor drove costs (89% on average). Training, project management, and partner engagement accounted for 78% of start-up costs on average. There was considerable variability in total and activity costs. Start-up activities provide an essential foundation for successful intervention delivery and sustainability, yet the resources needed and associated costs for this phase of intervention implementation do not receive much attention. We found that interventions faced unique start-up challenges and leverage points, resulting in differences in total cost and activity cost burden.