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. In prior work for non-VA settings, we evaluated the cost effectiveness of portfolios of interventions for opioid use to prevent HIV infection and found the cost effectiveness of interventions to vary tremendously.
The specific aims are to 1) assess the effectiveness of interventions for opioid use disorder; 2) assess the cost of interventions for opioid use disorder; and 3) evaluate the cost effectiveness and budget impact of interventions for opioid use disorder when used alone or in portfolios of interventions.
For Aim 1, we will develop estimates of the effectiveness and harms of the interventions based on the literature. We will rely on high-quality systematic reviews. We will update systematic reviews with searches of EMBASE, Medline/Pubmed, and other databases. We will adapt search strategies used in the recently revised VA/DOD Clinical Practice Guideline for the Management of Substance Use Disorders, developed with support from the Office of Quality, Safety, and Value in VA. We will prioritize randomized trials as a basis for estimates of effectiveness but will also consider observational studies as necessary. We will assess study quality using the approach developed by the U.S Preventive Services Task Force (USPSTF). We will abstract data 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 functioning.
For Aim 2, we will estimate costs from VA administrative data, including the VA Managerial Cost Accounting (MCA) data, Drug and Alcohol Program Survey (DAPS), Program Evaluation Research Center (PERC) data, and SAMHSA survey (N-SSATS), supplemented as needed by cost estimates from the literature.
For Aim 3, we will estimate health-related outcomes and costs in accordance with the recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine's new guidelines. We will assess the cost effectiveness of opioid use interventions in terms of dollars per additional unit of health benefit conferred. We will measure health outcomes comprehensively, including both short-term and long-term outcomes. Our primary measure of long-term outcome will be changes in quality-adjusted life years (QALYs). Our analyses will adopt a lifetime horizon. Our budget impact analysis will take the perspective of the VA and will estimate the utilization, costs and resource requirements for different VA stakeholders.
We anticipate that this study will assess the usefulness of these interventions in Veterans when used alone or in combination. Combinations of interventions may be synergistic or duplicative. We expect that this study will help clinicians and decision makers understand the benefits, cost and cost effectiveness of portfolios of interventions designed to reduce the morbidity and mortality of opioid use disorders.
The 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.
External Links for this Project
Grant Number: I01HX002457-01A1
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Mental, Cognitive and Behavioral Disorders, Substance Use Disorders, Musculoskeletal Disorders, Other Conditions
Treatment - Observational, Treatment - Comparative Effectiveness, TRL - Applied/Translational