September 2018

In This Issue: Improving Opioid Safety
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Cost-Effectiveness of Interventions to Reduce Morbidity from Opioid Dependency

Feature Article

Opioid dependence, overdose, and injection drug use have become a national public health crisis both in Veterans and non-Veterans. The consequences of failing to address opioid use are substantial, ranging from disabling dependence, organ failure, and even death. In an era of increasing budgetary constraints, VA and other effective healthcare systems face the challenge of how to prioritize these interventions to maximize benefit efficiently. Yet the cost effectiveness of these interventions in VA and elsewhere has not been rigorously determined in the current epidemic. Thus, the specific aims of this ongoing HSR&D study (2018–2020) are to:

• Assess the effectiveness of interventions for opioid use disorder,
• Determine the cost of interventions for opioid use disorder, and
• Evaluate the cost effectiveness and budget impact of interventions for opioid use disorder when used alone or in portfolios of interventions.

In order to accomplish these goals, investigators will develop estimates of the effectiveness and harms of the interventions based on the literature, relying on high-quality systematic reviews. Randomized trials will be prioritized, but investigators also will consider observational studies. Data will be analyzed on the following outcomes: illicit opioid use, injection behavior and rates, overdoses and mortality, health-related quality of life, property crime, and, if available, employment, incarceration, and mental health function. Costs will be estimated using VA data, and the cost effectiveness of opioid use interventions will be considered in terms of dollars per additional unit of health benefit conferred. Further, investigators will measure both short- and long-term health outcomes. The primary measure of long-term outcome will be changes in quality-adjusted life years (QALYs). Analyses will adopt a lifetime horizon. Budget impact analysis will take the perspective of VA and will estimate the utilization, costs, and resource requirements for different VA stakeholders.

Findings:
No findings to report at this time.

Impact: This study will provide an understanding of which interventions or combinations of interventions are likely to most improve the health of Veterans with opioid use disorder, along with estimates of the efficiency and total costs of the programs.  

Principal Investigator: Douglas Owens, MD, MS, is part of HSR&D’s Center for Innovation to Implementation (Ci2i): Fostering High-Value Care in Palo Alto, CA.

Additional Resources

• VHA Pain Management. Opioid Safety Initiative Toolkit.
• Veterans Crisis Line 1-800-273-8255 (press 1) or Text message to 838255.