TY - JOUR
AU - A. L. Claypool
AU - C. DiGennaro
AU - W. A. Russell
AU - M. F. Yildirim
AU - A. F. Zhang
AU - Z. Reid
AU - E. J. Stringfellow
AU - B. Bearnot
AU - B. R. Schackman
AU - K. Humphreys
AU - M. S. Jalali
A1 - 
AB - IMPORTANCE: Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity. OBJECTIVE: To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity. DESIGN AND SETTING: This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US. INTERVENTIONS: Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination. MAIN OUTCOMES AND MEASURES: Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective. RESULTS: Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously. CONCLUSION AND RELEVANCE: This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.
AD - Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston.;School of Population and Global Health, McGill University, Montreal, Quebec, Canada.;Division of General Internal Medicine, Massachusetts General Hospital, Boston.;Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.;Veterans Affairs and Stanford University Medical Centers, Palo Alto, California. MIT Sloan School of Management, Cambridge, Massachusetts.
AN - 37204803
BT - JAMA Health Forum
C5 - Opioids & Substance Use; Financing & Sustainability
CP - 5
DA - May 5
DO - 10.1001/jamahealthforum.2023.1080
DP - NLM
ET - 20230505
IS - 5
JF - JAMA Health Forum
LA - eng
N2 - IMPORTANCE: Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity. OBJECTIVE: To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity. DESIGN AND SETTING: This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US. INTERVENTIONS: Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination. MAIN OUTCOMES AND MEASURES: Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective. RESULTS: Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously. CONCLUSION AND RELEVANCE: This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective.
PY - 2023
SN - 2689-0186
SP - e231080
ST - Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids
T1 - Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids
T2 - JAMA Health Forum
TI - Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids
U1 - Opioids & Substance Use; Financing & Sustainability
U3 - 10.1001/jamahealthforum.2023.1080
VL - 4
VO - 2689-0186
Y1 - 2023
ER -