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Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Orme S, Zarkin GA, Dunlap LJ, Monico LB, Gryczynski J, Fishman MJ, Schwartz RP, O'Grady KE, Mitchell SG. Health care use and cost of treatment for adolescents and young adults with opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209137. [PMID: 37558183 PMCID: PMC10687977 DOI: 10.1016/j.josat.2023.209137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Few studies have examined the cost of medication for opioid use disorder (MOUD) with counseling for the adolescent and young adult population. This study calculated the health care utilization and cost of MOUD treatment, other substance use disorder treatment, and general health care for adolescents and young adults receiving treatment for opioid use disorder. METHODS The study randomized youth ages 15 to 21 (N = 288) equally into the two study conditions: extended-release naltrexone (XR-NTX) or treatment as usual (TAU). While participants committed to treatment based on randomization the study observed considerable nonadherence to both randomized conditions. Instead of using the randomly assigned study conditions, we present descriptive costs by the type of MOUD treatment received: XR-NTX only, buprenorphine only, any other combination of MOUD treatments, and no MOUD. Health care use was aggregated over the 6-month period for each participant, and we calculated average/participant utilization for each treatment group. To determine participant costs, we multiplied the unit costs of health care services obtained from the literature by the reported amount of health care utilization for each participant. We then calculated the mean, standard error, median and IQR for MOUD costs, other substance use disorder treatment costs and general healthcare cost from the health care sector perspective. RESULTS On average, participants in the XR-NTX only group received 2.6 doses of XR-NTX (equivalent to approximately 78 days of treatment). The buprenorphine only group had an average of 97 days of buprenorphine treatment. The XR-NTX only group had higher/patient costs compared to participants in the buprenorphine only group ($10,491 vs. $8765) and higher XR-NTX utilization would further increase costs. Participants in the any other MOUD combination group had the highest total costs ($14,627) while participants in the no MOUD group at the lowest ($3453). DISCUSSION Our cost analysis calculates the real-world cost of MOUD treatment and, while not generalizable, provides policy makers an estimate of costs for adolescents and young adults. We found that participants in the XR-NTX only group received fewer days of medication compared to the buprenorphine only group, but their medication costs were higher due to the cost of XR-NTX injections. While the buprenorphine only group had the highest number of days of medication utilization of all the groups, the average number of days of medication utilization was considerably shorter than the six-month treatment period.
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Affiliation(s)
- Stephen Orme
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA.
| | - Gary A Zarkin
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura J Dunlap
- RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
| | - Laura B Monico
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Marc J Fishman
- Mountain Manor Treatment Center, 3800 Frederick Avenue, Baltimore 21229, MD, USA
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Baxley C, Borsari B, Reavis JV, Manuel JK, Herbst E, Becker W, Pennington D, Batki SL, Seal K. Effects of buprenorphine on opioid craving in comparison to other medications for opioid use disorder: A systematic review of randomized controlled trials. Addict Behav 2023; 139:107589. [PMID: 36565531 DOI: 10.1016/j.addbeh.2022.107589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Craving is a distressing symptom of opioid use disorder (OUD) that can be alleviated with medications for OUD (MOUD). Buprenorphine is an effective MOUD that may suppress craving; however, treatment discontinuation and resumed opioid use is common during the early phases of treatment. More information on the craving response through the high-risk period of initiating buprenorphine may provide meaningful information on how to better target craving, which in turn may enhance outcomes. This systematic review investigated buprenorphine doses and formulations on craving during the induction and maintenance phases of treatment, and for context also compared the craving response to other MOUD (i.e., methadone, extended-release naltrexone [XR-NTX]). METHODS PubMed, PsycInfo, Embase, and Cochrane Central databases were searched for randomized trials of buprenorphine versus placebo, various buprenorphine formulations/doses, or other MOUD that included a measure of opioid craving. RESULTS A total of 10 studies were selected for inclusion. Buprenorphine and buprenorphine/naloxone (BUP/NAL) were each associated with lower craving than placebo over time. Craving was greater among those prescribed lower versus higher buprenorphine doses. In comparison to other MOUD, buprenorphine or BUP/NAL was linked to greater craving than methadone in 3 of the 6 studies. BUP/NAL was associated with greater reported craving than XR-NTX. DISCUSSION Craving is reduced over time with buprenorphine and BUP/NAL, although other MOUD may provide greater reductions in craving. Although there is currently considerable variability in the measurement of craving, it may be a valuable concept to address with individuals receiving MOUD, especially early in treatment.
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Affiliation(s)
- Catherine Baxley
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Brian Borsari
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Jill V Reavis
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States; Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, United States
| | - Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Ellen Herbst
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - William Becker
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, United States; Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - David Pennington
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Steven L Batki
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Karen Seal
- San Francisco Veterans Affairs Health Care System, 4150 Clement St, San Francisco, CA 94121, United States; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
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Cerdá M, Jalali MS, Hamilton AD, DiGennaro C, Hyder A, Santaella-Tenorio J, Kaur N, Wang C, Keyes KM. A Systematic Review of Simulation Models to Track and Address the Opioid Crisis. Epidemiol Rev 2021; 43:147-165. [PMID: 34791110 DOI: 10.1093/epirev/mxab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023] Open
Abstract
The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, and nonlinear social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,398 articles screened, we identified 88 eligible articles. The most frequent types of models were compartmental (36%), Markov (20%), system dynamics (16%), and Agent-Based models (16%). Over a third evaluated intervention cost-effectiveness (40%), and another third (39%) focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (61%) discussed calibrating their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 63 studies that provided model parameters, we extracted the data sources on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality parameters. This database offers a tool that future modelers can use to identify potential model inputs and evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.
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Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Ava D Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, and Translational Data Analytics Institute, The Ohio State University, Columbus, Ohio
| | - Julian Santaella-Tenorio
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Navdep Kaur
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Christina Wang
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Wei LC, Chan HY. Relationship between choice of opioid agonist therapy and distance from patients' residences in Taiwan, 2012-2014. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:590-598. [PMID: 34402338 DOI: 10.1080/00952990.2021.1955896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Choice of opioid agonist therapy (OAT) for opioid use disorder (OUD) can be impacted by variables such as age, sex, and socioeconomic status. However, it remains unknown whether accessibility of treatment affects patient choice of OAT. OBJECTIVES To investigate the association between distance to the treatment site and choice of OAT. METHODS Electronic records were collected for the last outpatient visits of individuals with OUD between January 1, 2012 and December 31, 2014. The address of each patient was processed using the Geographic Information System to obtain the distance between place of residence and the hospital. Multivariate logistic regression was used to assess the correlation between individual drug selection and distance of residence. Among the study population of 2804 patients (81.5% male), 74.1% were receiving methadone while 25.8% were receiving buprenorphine. The vast majority (95%) of all patients lived within 50 km of the hospital, so regression analysis was limited to this distance. Sensitivity analysis was estimated using robust Poisson regression. RESULTS Logistic regression revealed that every 1-km increase in distance from home to hospital increased the odds ratio of choosing sublingual buprenorphine tablets over methadone by 1.05 (p = .02, 95% confidence interval (CI) = 1.02-1.08). CONCLUSIONS Patients living closer to the treatment center were more likely to choose methadone as treatment, while patients living farther away were more likely to choose sublingual buprenorphine tablets. To mitigate the influence of travel distance on therapy choice, we recommend that more medical institutions participate in OAT services.
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Affiliation(s)
- Lien-Chung Wei
- Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Counseling and Industrial/Organizational Psychology, Ming-Chuan University, Taoyuan, Taiwan.,Division of Epidemiology, School of Public Health, UC Berkeley, Berkeley, CA, USA
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Beaulieu E, DiGennaro C, Stringfellow E, Connolly A, Hamilton A, Hyder A, Cerdá M, Keyes KM, Jalali MS. Economic Evaluation in Opioid Modeling: Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:158-173. [PMID: 33518022 PMCID: PMC7864393 DOI: 10.1016/j.jval.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. METHODS A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. RESULTS The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. CONCLUSION The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.
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Affiliation(s)
- Elizabeth Beaulieu
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Catherine DiGennaro
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Erin Stringfellow
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Connolly
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ayaz Hyder
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA; Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Zarkin GA, Orme S, Dunlap LJ, Kelly SM, Mitchell SG, O'Grady KE, Schwartz RP. Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail. Drug Alcohol Depend 2020; 217:108292. [PMID: 32992151 PMCID: PMC7736121 DOI: 10.1016/j.drugalcdep.2020.108292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group. METHODS We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective. RESULTS The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs. CONCLUSIONS IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.
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Affiliation(s)
- Gary A Zarkin
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Stephen Orme
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
| | - Laura J Dunlap
- RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States
| | - Sharon M Kelly
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Shannon G Mitchell
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, 4094 Campus Drive, College Park, MD 20742, United States
| | - Robert P Schwartz
- Friends Research Institute, 1040 Park Avenue Suite 103. Baltimore, MD 21201, United States
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Barbosa C, Dowd WN, Zarkin G. Economic Evaluation of Interventions to Address Opioid Misuse: A Systematic Review of Methods Used in Simulation Modeling Studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1096-1108. [PMID: 32828223 DOI: 10.1016/j.jval.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/28/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Several evidence-based interventions exist for people who misuse opioids, but there is limited guidance on optimal intervention selection. Economic evaluations using simulation modeling can guide the allocation of resources and help tackle the opioid crisis. This study reviews methods employed by economic evaluations using computer simulations to investigate the health and economic effects of interventions meant to address opioid misuse. METHODS We conducted a systematic mapping review of studies that used simulation modeling to support the economic evaluation of interventions targeting prevention, treatment, or management of opioid misuse or its direct consequences (ie, overdose). We searched 6 databases and extracted information on study population, interventions, costs, outcomes, and economic analysis and modeling approaches. RESULTS Eighteen studies met the inclusion criteria. All of the studies considered only one segment of the continuum of care. Of the studies, 13 evaluated medications for opioid use disorder, and 5 evaluated naloxone distribution programs to reduce overdose deaths. Most studies estimated incremental cost per quality-adjusted life-years and used health system and/or societal perspectives. Models were decision trees (n = 4), Markov (n = 10) or semi-Markov models (n = 3), and microsimulations (n = 1). All of the studies assessed parameter uncertainty though deterministic and/or probabilistic sensitivity analysis, 4 conducted formal calibration, only 2 assessed structural uncertainty, and only 1 conducted expected value of information analyses. Only 10 studies conducted validation. CONCLUSIONS Future economic evaluations should consider synergies between interventions and examine combinations of interventions to inform optimal policy response. They should also more consistently conduct model validation and assess the value of further research.
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Affiliation(s)
- Carolina Barbosa
- Behavioral Health Research Division, RTI International, Chicago, IL, USA.
| | - William N Dowd
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Gary Zarkin
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
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Andraka-Christou B, Nguyen T, Bradford DW, Simon K. Assessing the impact of drug courts on provider-directed marketing efforts by manufactures of medications for the treatment of opioid use disorder. J Subst Abuse Treat 2019; 110:49-58. [PMID: 31952628 DOI: 10.1016/j.jsat.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/31/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within the criminal justice system (Hedrich et al., 2012; Medications for Opioid Use Disorder Save Lives, 2019; Moore et al., 2019).While a stronger evidence base exists for agonist MOUD than for antagonist MOUD, a national study of drug courts found that half prohibited agonist MOUD (Matusow et al., 2013).Furthermore, recent media reports suggest that the pharmaceutical manufacturer of an antagonist MOUD has marketed its product towards drug court judges (Goodnough & Zernike, 2017; Harper, 2017). However, no study to date has systematically examined the relationship between MOUD marketing practices and drug courts. This ecological study examines the association at the county level between MOUD manufacturer payments to prescribers and drug court locations. METHOD We extracted provider-directed payments from Centers for Medicare and Medicaid Services (CMS)'s Sunshine Act Open Payments data 2014-2017, isolating those records mentioning any MOUD. We compared provider-directed payments for two major MOUDs: buprenorphine and extended-release naltrexone, in counties with and without drug courts. RESULTS The presence of any adult drug courts in the county is associated with a 7.86 percentage-point increase in the likelihood of providers in that county receiving any MOUD-related payments (about 22.46% of the sample mean, p<0.001) and with a 10.70% increase in the amount of these payments per 1000 county residents (p<0.001). The association between other forms of drug courts such as juvenile drug courts and Driving-Under-the-Influence courts (DUI) courts are less significant and slightly smaller in magnitude compared to those of adult drug courts. We did not find significant difference between payments by the manufacturer of Vivitrol and manufacturers of Zubsolv, Bunavail, and Suboxone (oral forms of buprenorphine). CONCLUSIONS Our results show an ecological association at the county level between MOUD manufacturer payments to prescribers and drug court presence. However, we did not examine a causal association between these variables.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management & Informatics, University of Central Florida, United States of America.
| | - Thuy Nguyen
- Paul H. O'Neill School of Public & Environmental Affairs, Indiana University-Bloomington, United States of America
| | - David W Bradford
- Department of Public Administration and Policy, University of Georgia, United States of America
| | - Kosali Simon
- Paul H. O'Neill School of Public & Environmental Affairs, Indiana University-Bloomington, United States of America
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Barbosa C, Fraser H, Hoerger TJ, Leib A, Havens JR, Young A, Kral A, Page K, Evans J, Zibbell J, Hariri S, Vellozzi C, Nerlander L, Ward JW, Vickerman P. Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. Addiction 2019; 114:2267-2278. [PMID: 31307116 PMCID: PMC7751348 DOI: 10.1111/add.14731] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/19/2018] [Accepted: 06/28/2019] [Indexed: 12/12/2022]
Abstract
AIMS To examine the cost-effectiveness of hepatitis C virus (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States. DESIGN HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. SETTING Rural Perry County, KY (PC) and urban San Francisco, CA (SF), USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings. PARTICIPANTS PWID data were collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study and National HIV Behavioral Surveillance System studies. INTERVENTIONS AND COMPARATOR Three intervention scenarios modeled: baseline-existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; intervention 1-scale-up of SSP and MAT without changes to treatment; and intervention 2-scale-up as intervention 1 combined with HCV screening and treatment for current PWID. MEASUREMENTS Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). FINDINGS For both settings, intervention 2 is preferred to intervention 1 and the appropriate comparator for intervention 2 is the baseline scenario. Relative to baseline, for PC intervention 2 averts 1852 more HCV infections, increases QALYS by 3095, costs $21.6 million more and has an ICER of $6975/QALY. For SF, intervention 2 averts 36 473 more HCV infections, increases QALYs by 7893, costs $872 million more and has an ICER of $11 044/QALY. The cost-effectiveness of intervention 2 was robust to several sensitivity analysis. CONCLUSIONS Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States.
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Affiliation(s)
| | | | | | - Alyssa Leib
- Department of Chemistry, University of Colorado, Denver, USA
| | | | - April Young
- University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Alex Kral
- RTI International, Research Triangle Park, NC, USA
| | - Kimberly Page
- University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | | | - Jon Zibbell
- RTI International, Research Triangle Park, NC, USA
| | - Susan Hariri
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lina Nerlander
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John W. Ward
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Court personnel attitudes towards medication-assisted treatment: A state-wide survey. J Subst Abuse Treat 2019; 104:72-82. [DOI: 10.1016/j.jsat.2019.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023]
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Makarenko I, Pykalo I, Springer SA, Mazhnaya A, Marcus R, Filippovich S, Dvoriak S, Altice FL. Treating opioid dependence with extended-release naltrexone (XR-NTX) in Ukraine: Feasibility and three-month outcomes. J Subst Abuse Treat 2019; 104:34-41. [PMID: 31370983 PMCID: PMC8215516 DOI: 10.1016/j.jsat.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/11/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although opioid agonist treatments (OAT) with methadone or buprenorphine are available to treat opioid use disorders (OUD) in Ukraine, OAT acceptability and coverage remains low. Extended-release naltrexone (XR-NTX) that recently became available as another treatment option provides new opportunities for treating OUDs in this region and we aimed to test its feasibility. METHODS Patients with OUD (N=135) and interested in treatment with XR-NTX were initiated on monthly XR-NTX injections and monitored for three months. Correlates of 3-month retention on XR-NTX and drug use at each time-point using self-reports and urine drug testing (UDT) were assessed. RESULTS Of the 134 participants initiated XR-NTX, 101 (75%) completed three months, defined as 4 consecutive XR-NTX injections. Independent factors negatively associated with retention in XR-NTX treatment included previous maintenance with OAT (aOR=0.3; 95%CI=0.1-0.9) and extrinsic help-seeking treatment motivation (aOR=0.7; 95%CI=0.5-0.9). Of these 101 participants completing three months of treatment, opioid use markedly reduced using self-report (67%% to 22%; p>0.001) and UDT (77% to 24%; p<0.001) outcomes over time. Alcohol, marijuana and stimulant use, however, remained unchanged. Craving for opioids and symptoms of depression also significantly decreased, while health-related quality of life scores improved over time. No adverse side effects were reported during the period of observation. CONCLUSION The first introduction of XR-NTX in Ukraine among persons with OUD resulted in high levels of retention, marked reductions in opioid use and improved quality of life. These descriptive results suggest that XR-NTX treatment is feasible and well-tolerated over a 3-month period in Ukraine.
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Affiliation(s)
- Iuliia Makarenko
- ICF Alliance for Public Health, Kyiv, Ukraine; Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sandra A Springer
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Alyona Mazhnaya
- ICF Alliance for Public Health, Kyiv, Ukraine; Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine; Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Andrews CM, Grogan CM, Smith BT, Abraham AJ, Pollack HA, Humphreys K, Westlake MA, Friedmann PD. Medicaid Benefits For Addiction Treatment Expanded After Implementation Of The Affordable Care Act. Health Aff (Millwood) 2019; 37:1216-1222. [PMID: 30080460 DOI: 10.1377/hlthaff.2018.0272] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Columbia regarding their addiction treatment benefits and utilization controls in standard and alternative benefit plans in 2014 and 2017, when plans were subject to ACA parity requirements. The number of state plans that provided benefits for residential treatment and opioid use disorder medications increased substantially. States imposing annual service limits on outpatient addiction treatment decreased by over 50 percent. Fewer states required preauthorization for services, with the largest reductions for medications treating opioid use disorder. The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans. This trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.
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Affiliation(s)
- Christina M Andrews
- Christina M. Andrews ( ) is an assistant professor in the College of Social Work, University of South Carolina, in Columbia
| | - Colleen M Grogan
- Colleen M. Grogan is a professor in the School of Social Service Administration, University of Chicago, in Illinois
| | - Bikki Tran Smith
- Bikki Tran Smith is a PhD student in the School of Social Service Administration, University of Chicago
| | - Amanda J Abraham
- Amanda J. Abraham is an assistant professor in the School of Public and International Affairs, University of Georgia, in Athens
| | - Harold A Pollack
- Harold A. Pollack is the Helen Ross Professor in the School of Social Service Administration, University of Chicago
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences in the Department of Psychiatry, Stanford School of Medicine, and a senior research career scientist at the Veterans Affairs Palo Alto Health Care System, both in California
| | - Melissa A Westlake
- Melissa A. Westlake is a PhD student in College of Social Work, University of South Carolina
| | - Peter D Friedmann
- Peter D. Friedmann is chief research officer for academic affairs at Baystate Health, in Springfield, Massachusetts
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15
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Burgos JL, Cepeda JA, Kahn JG, Mittal ML, Meza E, Lazos RRP, Vargas PC, Vickerman P, Strathdee SA, Martin NK. Cost of provision of opioid substitution therapy provision in Tijuana, Mexico. Harm Reduct J 2018; 15:28. [PMID: 29792191 PMCID: PMC5967039 DOI: 10.1186/s12954-018-0234-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. METHODS We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. RESULTS The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose. CONCLUSIONS The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.
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Affiliation(s)
- Jose Luis Burgos
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Javier A Cepeda
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.
| | - James G Kahn
- Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Maria Luisa Mittal
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | | | | | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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16
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Shah A, Duncan M, Atreja N, Tai KS, Gore M. Healthcare utilization and costs associated with treatment for opioid dependence. J Med Econ 2018; 21:406-415. [PMID: 29320915 DOI: 10.1080/13696998.2018.1427101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Opioid use disorder (OUD) can be managed with medication assisted therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy [NPT]). The objective of this study was to evaluate healthcare resource utilization and costs associated with XR-NTX compared with alternative treatments for opioid dependence. METHODS Adults with a diagnosis of opioid dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between January 1, 2011 and December 31, 2014 were identified in the Truven Health MarketScan Commercial administrative claims database. Healthcare resource utilization, costs (inpatient [IP], emergency department [ED], outpatient [OP], and pharmacy) and adherence were evaluated for each cohort during 12-month baseline and follow-up periods. RESULTS A total of 29,235 patients were included in the analysis; 1,041, 20,566, 745, and 6,883 received XR-NTX, BUP, MET, and NPT, respectively. Patients in the XR-NTX cohort were significantly younger and had more comorbidities compared with the other cohorts. Patients in the XR-NTX group had the largest percentage decrease in IP and ED utilization and costs from baseline to follow-up. OP and pharmacy costs increased significantly from baseline to follow-up for all cohorts. Overall, there was no significant change in total healthcare costs for the XR-NTX group, whereas the costs increased significantly for other groups (BUP = +43%, MET = +47.7%, NPT = +38.8%). CONCLUSIONS Healthcare resource utilization and costs increased from baseline to follow-up in BUP, MET, and NPT patients, whereas patients receiving XR-NTX experienced no such increase. This analysis suggests there may be economic value in the use of XR-NTX for OUD.
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17
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Fraser H, Zibbell J, Hoerger T, Hariri S, Vellozzi C, Martin NK, Kral AH, Hickman M, Ward JW, Vickerman P. Scaling-up HCV prevention and treatment interventions in rural United States-model projections for tackling an increasing epidemic. Addiction 2018; 113:173-182. [PMID: 28734093 PMCID: PMC6211174 DOI: 10.1111/add.13948] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/06/2017] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. SETTING Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. PARTICIPANTS PWID. MEASUREMENTS Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
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Affiliation(s)
- Hannah Fraser
- Social and Community Medicine, University of Bristol, UK
| | - Jon Zibbell
- RTI International, Research Triangle Park, USA
| | | | - Susan Hariri
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Natasha K Martin
- Social and Community Medicine, University of Bristol, UK,Division of Global Public Health, University of California San Diego, California, USA
| | | | | | - John W. Ward
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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18
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Murphy SM, Polsky D, Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Bonnie RJ, Gordon M, Chen DT, Boney TY, O’Brien CP. Cost-effectiveness of extended release naltrexone to prevent relapse among criminal justice-involved individuals with a history of opioid use disorder. Addiction 2017; 112:1440-1450. [PMID: 28239984 PMCID: PMC5503784 DOI: 10.1111/add.13807] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/01/2016] [Accepted: 02/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol® ) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. DESIGN Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. SETTING Five study sites in the US Northeast corridor. PARTICIPANTS A total of 308 participants were randomized to XR-NTX (n = 153) or TAU (n = 155). MEASUREMENTS Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. FINDINGS The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. CONCLUSIONS While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection.
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Affiliation(s)
- Sean M. Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics, University of
Pennsylvania, Philadelphia, PA
| | - Joshua D. Lee
- Department of Population Health, Medicine, Division of General
Internal Medicine and Clinical Innovation, New York University, New York, NY
| | - Peter D. Friedmann
- Department of Baystate Health, University of Massachusetts Medical
School-Baystate, Springfield, MA
| | - Timothy W. Kinlock
- Department of Friends Research Institute, Baltimore, MD
- Department of School of Criminal Justice, University of Baltimore,
Baltimore, MD
| | - Edward V. Nunes
- Department of New York State Psychiatric Institute, Columbia
University College of Physicians and Surgeons, New York, NY
| | - Richard J. Bonnie
- Department of School of Law, University of Virginia,
Charlottesville, VA
| | | | - Donna T. Chen
- Department of Center for Biomedical Ethics and Humanities,
University of Virginia Health System, Charlottesville, VA
| | - Tamara Y. Boney
- Department of Corporal Michael J. Crescenz Veterans Affairs Medical
Center, Philadelphia, PA
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19
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Carter JA, Dammerman R, Frost M. Cost-effectiveness of subdermal implantable buprenorphine versus sublingual buprenorphine to treat opioid use disorder. J Med Econ 2017; 20:893-901. [PMID: 28604141 DOI: 10.1080/13696998.2017.1341416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Subdermal implantable buprenorphine (BSI) was recently approved to treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal clinical trial, BSI was associated with a higher proportion of completely-abstinent patients (85.7% vs 71.9%; p = .03) vs sublingual buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated with diminished treatment outcomes and increased costs. This study evaluated the cost-effectiveness of BSI vs SL-BPN from a US societal perspective. METHODS A Markov model simulated BSI and SL-BPN cohorts (clinically-stable adults) transiting through four mutually-exclusive health states for 12 months. Cohorts accumulated direct medical costs from drug acquisition/administration; treatment-diversion/abuse; newly-acquired hepatitis-C; emergency room, hospital, and rehabilitation services; and pediatric poisonings. Non-medical costs of criminality, lost wages/work-productivity, and out-of-pocket expenses were also included. Transition probabilities to a relapsed state were derived from the aforementioned trial. Other transition probabilities, costs, and health-state utilities were derived from observational studies and adjusted for trial characteristics. Outcomes included incremental cost per quality-adjusted-life-year (QALY) gained and incremental net-monetary-benefit (INMB). Uncertainty was assessed by univariate and probabilistic sensitivity analysis (PSA). RESULTS BSI was associated with lower total costs (-$4,386), more QALYs (+0.031), and favorable INMB at all willingness-to-pay (WTP) thresholds considered. Higher drug acquisition costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency room/hospital utilization (-$8,040) and criminality (-$1,212). BSI was cost-effective in 89% of PSA model replicates, and had a significantly higher NMB at $50,000/QALY ($20,783 vs $15,007; p < .05). CONCLUSIONS BSI was preferred over SL-BPN from a health-economic perspective for treatment of OUD in clinically-stable adults. These findings should be interpreted carefully, due to some relationships having been modeled from inputs derived from multiple sources, and would benefit from comparison with outcomes from studies that employ administrative claims data or a naturalistic comparative design.
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Affiliation(s)
| | - Ryan Dammerman
- b Formerly of Braeburn Pharmaceuticals , Princeton , NJ , USA
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20
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Abstract
BACKGROUND The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage adoption of a given therapy-nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. OBJECTIVE The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. METHODS We performed a systematic review of the major electronic databases from inception until August 2015. A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of the existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic evaluation studies according to their quality. RESULTS A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n = 49) were included in this study. Six of the included articles were reviews. The remaining 43 articles reported economic evaluation studies of interventions for opioid use disorders. In general, the evidence on methadone maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid use disorder therapy. The economic literature comparing MMT with other opioid use disorder pharmacotherapies is limited, as is the literature on other forms of therapy. CONCLUSION With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid use disorder interventions.
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Affiliation(s)
- Sean M Murphy
- Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA.
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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21
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Hoang VP, Shanahan M, Shukla N, Perez P, Farrell M, Ritter A. A systematic review of modelling approaches in economic evaluations of health interventions for drug and alcohol problems. BMC Health Serv Res 2016; 16:127. [PMID: 27074871 PMCID: PMC4831174 DOI: 10.1186/s12913-016-1368-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The overarching goal of health policies is to maximize health and societal benefits. Economic evaluations can play a vital role in assessing whether or not such benefits occur. This paper reviews the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to (i) modelling paradigms themselves; (ii) perspectives of costs and benefits and (iii) time frame. Methods Papers that use modelling approaches for economic evaluations of drug and alcohol interventions were identified by carrying out searches of major databases. Results Thirty eight papers met the inclusion criteria. Overall, the cohort Markov models remain the most popular approach, followed by decision trees, Individual based model and System dynamics model (SD). Most of the papers adopted a long term time frame to reflect the long term costs and benefits of health interventions. However, it was fairly common among the reviewed papers to adopt a narrow perspective that only takes into account costs and benefits borne by the health care sector. Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1368-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Van Phuong Hoang
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - Marian Shanahan
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Nagesh Shukla
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Pascal Perez
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
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