The Value of Shorter Initial Opioid Prescriptions: A Simulation Evaluation
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During the period from 1999 to 2016, more than 350,000 Americans died from overdoses related to the use of prescription opioids. To the extent that supply is directly related to overprescribing, policy interventions aimed at changing prescriber behavior, such as the recent Centers for Disease Control and Prevention guideline, are clearly warranted. Although these could plausibly reduce the prevalence of opioid overuse and dependency, little is known about their economic and health-related impacts.
The aim of this study was to quantify the efficacy of a policy intervention aimed at reducing the length of initial opioid prescriptions.
Study Design and Methods
A Markov decision process model was fitted on a retrospective cohort of 827,265 patients, and patient cost and health trajectories were simulated over a 24-month period. The model’s parameters were based on patients who received short (≤ 3 days) or long (> 7 days) initial opioid prescriptions, matched using propensity score methods.
All active-duty US Army soldiers from 2011 to 2014; the data contained detailed medical and administrative information on over 11 million soldier-months corresponding to 827,265 individual soldiers.
Main Outcome Measure
Overall costs of a policy change, quality-adjusted life-years (QALYs) gained, and $/QALY gained.
Over a 2-year horizon, a reassignment of 10,000 patients to short initial duration would generate a cost saving in the vicinity of $3.1 million (excluding program costs), and would also lead to an estimated 4451 additional opioid-free months, i.e. months without any opioid prescriptions.
The analysis found that efforts to change prescriber behavior can be cost effective, and further studies into the implementation of such policies are warranted.
The authors gratefully acknowledge the support of the National Institute for Healthcare Management (NIHCM) Foundation to the Principal Investigator, Ritu Agarwal.
The interpretation and reporting of the results are the sole responsibility of the authors. Dr. Bjarnadottir acts as guarantor of the work presented in this paper. Dr. Bjarnadottir contributed to the study design, data extraction, interpretation of the analysis, and writing of the manuscript. Dr. Anderson contributed to the study design, data analysis, interpretation of the results, and writing of the manuscript. Dr. Prasad built the simulation model and ran the analysis, and contributed to the study design, data analysis, and writing of the manuscript. Dr. Agarwal contributed to the study design, interpretation of the results, and writing of the manuscript. Dr. Nelson conducted the data collection and the initial structure of the study dataset, and contributed to writing of the manuscript.
Compliance with Ethical Standards
Conflict of interest
Margret V. Bjarnadottir, David Anderson, Kislaya Prasad, Al Nelson, and Ritu Agarwal have no other conflicts of interest to declare.
- 4.Castlight Health. The Opioid Crisis in America’s Workforce. https://content.castlighthealth.com/Opioid-Research-Report_LP.html. 2016. Accessed 9 Mar 2019.
- 5.Lipari RN, Hughes A. How people obtain the prescription pain relievers they misuse. The CBHSQ Report. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2017. https://www.ncbi.nlm.nih.gov/books/NBK424785/. Accessed 9 Mar 2019.
- 6.CNN Library: Opioid Crisis Fast Facts. https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html. Accessed 9 Mar 2019.
- 11.Radcliffe S. Will limiting opioid prescriptions to 7 days have an impact? Health News; 2017. https://www.healthline.com/health-news/will-limiting-opioid-prescriptions-have-impact#1. Accessed 9 Mar 2019.
- 18.U.S. Army Recruiting Command. https://recruiting.army.mil/. Accessed 15 Jan 2018.
- 19.War and Sacrifice in the Post-9/11 Era. Washington, DC: Pew Research Center; 2011.Google Scholar
- 20.QALY. Segen’s Medical Dictionary; 2011. https://medical-dictionary.thefreedictionary.com/QALY. Accessed 27 Oct 2018.
- 24.Neumann PJ, Sanders GD, Russel LB, Siegel JE, Ganiats TG, editors. Cost-effectiveness in health and medicine. 2nd ed. New York: Oxford University Press; 2017.Google Scholar
- 27.Institute for Clinical and Economic Review. Institute for Clinical and Economic Review posts revised value assessment framework for public comment; 2017. https://icer-review.org/announcements/vaf-revision-public-comment/. Accessed 9 Mar 2019.
- 28.US Army. Army Regulation 40-501. Standards of Medical Fitness; 2017. https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/ARN3801_AR40-501_Web_FINAL.pdf. Accessed 9 Mar 2019.
- 29.Centers for Disease Control and Prevention. Prescription Opioid data; 2018. https://www.cdc.gov/drugoverdose/data/prescribing.html. Accessed 13 Mar 2019.
- 32.Thaler R, Sunstein C. Nudge: improving decisions about health, wealth, and Happiness. New Haven: Yale University Press; 2008.Google Scholar