Medication Therapy for Opioid Use Disorder Saves Lives and Can Save Money for Society
BACKGROUND:
Opioid overdose deaths in the United States reached a record high of 50,042 in 2019 and likely increased in 2020 because COVID-19 resulted in an increase in substance use, exacerbated stress and social isolation, and interfered with opioid treatment. This also has increased the number of people with opioid use disorder (OUD) that do not receive any form of medication-assisted treatment (MAT), with methadone, buprenorphine, or extended-release naltrexone – or overdose education and naloxone distribution (OEND). Investigators in this study developed a mathematical model to assess the cost-effectiveness of OUD treatments and the association of these treatments with outcomes in the US. Specifically, investigators assessed fatal and non-fatal overdoses and deaths over five years along with lifetime quality-adjusted life-years (QALYs) and costs for different treatments such as possible combinations of MAT with add-on treatments such as psychotherapy, overdose education and naloxone distribution, as well as Contingency Management (CM; sometimes referred to as “motivational incentives”), which resulted in 26 treatment options, including the possibility of no treatment. Two analyses were done, the first considering only health sector costs, and the second also considering criminal justice costs.
FINDINGS:
- Medication-assisted treatment, with or without OEND, CM, and psychotherapy, is associated with significant health benefits and is cost-effective compared to usual benchmarks when considering only healthcare costs.
- When criminal justice costs were included in addition to healthcare costs, all forms of MAT (buprenorphine, methadone, and naltrexone) were cost-saving compared with no treatment, yielding savings of $25,000 to $105,000 in lifetime costs per individual.
- An analysis using demographics and cost data for VA yielded similar findings, but QALY gains from treatment were lower due to Veterans being older, on average, than the general population.
IMPLICATIONS:
- Policymakers and many members of Congress have proposed expanding access to MAT and OEND. These results indicate that such a policy, especially if it includes CM, would generate significant societal cost savings – and, more importantly, would save numerous lives.
LIMITATIONS:
- Model parameter values were informed by available data, which was limited in some cases.
- All available forms of MAT (e.g., extended-release buprenorphine) were not considered.
- Costs associated with lost productivity, social services (e.g., child welfare), and housing (e.g., homelessness) were not considered due to the uncertainty about such costs.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 17-139). Drs. Humphreys, Oliva, Asch, and Owens are part of HSR&D’s Center for Innovation to Implementation (Ci2i). Drs. Joyce and Bounthavong are part of HSR&D’s Health Economics Resource Center (HERC).
Fairley M, Humphreys K, Joyce V, Bounthavong M, Trafton J, Combs A, Oliva E, Goldhaber-Fiebert J, Asch S, Brandeau M, and Owens D. Cost-Effectiveness of Treatments for Opioid Use Disorder. JAMA Psychiatry. March 31, 2021; online ahead of print.
