Economic Evaluations of Opioid Use Disorder Interventions
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.
The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions.
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.
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.
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.
- 1.United Nations Office on Drugs and Crime. World drug report 2014. New York: United Nations; 2014.Google Scholar
- 2.World Health Organization. Information sheet on opioid overdose. Geneva: World Health Organization; 2014. http://www.who.int/substance_abuse/information-sheet/en. Accessed 2 Jun 2015.
- 5.Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Phys. 2008;11(2):S63–88.Google Scholar
- 10.World Health Organization. Neuroscience of psychoactive substance use and dependence. Geneva: World Health Organization; 2004.Google Scholar
- 11.National Quality Forum. National voluntary consensus standards for the treatment of substance use conditions: evidence-based treatment practices. Washington, DC: National Quality Forum; 2007.Google Scholar
- 14.Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;(3):CD002209. doi:10.1002/14651858.CD002209.pub2.
- 15.Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;(2):CD002207. doi:10.1002/14651858.CD002207.pub3.
- 17.Alkermes, Inc. Vivitrol® (naltrexone for extended-release injectable suspension) intramuscular: US prescribing information. Waltham: Alkermes, Inc.; 2010.Google Scholar
- 18.Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Rockville: Substance Abuse and Mental Health Services Administration (SAMHSA); 2004.Google Scholar
- 19.Adi Y, Juarez-Garcia A, Wang D, Jowett S, Frew E, Day E, et al. Oral naltrexone as a treatment for relapse prevention in formerly opioid-dependent drug users: a systematic review and economic evaluation. Health Technol Assess. 2007;11(6):iii–iv, 1–85.Google Scholar
- 20.Canadian Agency for Drugs and Technologies in Health. Suboxone versus methadone for the treatment of opioid dependence: a review of the clinical and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2013.Google Scholar
- 21.Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor R, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess (Winchester, England). 2007;11(9):1–171, iii–iv.Google Scholar
- 25.Hayhurst KP, Leitner M, Davies L, Flentje R, Millar T, Jones A, et al. The effectiveness and cost-effectiveness of diversion and aftercare programmes for offenders using class A drugs: a systematic review and economic evaluation. Health Technol Assess (Winchester, England). 2015;19(6):1–168.CrossRefGoogle Scholar
- 27.Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2008.Google Scholar
- 32.Geitona M, Carayanni V, Petratos P. Economic evaluation of opioid substitution treatment in Greece. Heroin Addict Relat Clin Probl. 2012;14(3):77–88.Google Scholar
- 35.Shanahan M, Mattick RP. Choosing treatments: the role of economics in informing future decisions. In: Mattick R, Ali R, Lintzeris N, editors. Pharmacotherapies for the treatment of opioid dependence: efficacy, cost-effectiveness and implementation guidelines: New York: Informa; 2009:475–88.Google Scholar
- 46.Khemiri A, Kharitonova E, Zah V, Ruby J, Toumi M. Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims. Postgrad Med. 2014;126(5):113–20.CrossRefPubMedGoogle Scholar
- 57.World Health Organization. Cost effectiveness and strategic planning (WHO-CHOICE): threshold values for intervention cost-effectiveness by region. Geneva: World Health Organization; 2015. http://www.who.int/choice/costs/CER_levels/en/. Accessed 14 Mar 2016
- 73.White H, Sabarwal S. Quasi-experimental design and methods: methodological briefs—impact evaluation No. 8. Unicef Office of Research—Innocenti; 2014. http://www.unicef-irc.org/publications/753/.
- 74.Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.Google Scholar