A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence

Abstract

BackgroundOpioid dependence is a chronic condition with substantial health, economic and social costs. The study objective was to conduct a systematic review of published health-economic models of opioid agonist therapy for non-prescription opioid dependence, to review the different modelling approaches identified, and to inform future modelling studies. MethodsLiterature searches were conducted in March 2015 in eight electronic databases, supplemented by hand-searching reference lists and searches on six National Health Technology Assessment Agency websites. Studies were included if they: investigated populations that were dependent on non-prescription opioids and were receiving opioid agonist or maintenance therapy; compared any pharmacological maintenance intervention with any other maintenance regimen (including placebo or no treatment); and were health-economic models of any type.ResultsA total of 18 unique models were included. These used a range of modelling approaches, including Markov models (n = 4), decision tree with Monte Carlo simulations (n = 3), decision analysis (n = 3), dynamic transmission models (n = 3), decision tree (n = 1), cohort simulation (n = 1), Bayesian (n = 1), and Monte Carlo simulations (n = 2). Time horizons ranged from 6 months to lifetime. The most common evaluation was cost-utility analysis reporting cost per quality-adjusted life-year (n = 11), followed by cost-effectiveness analysis (n = 4), budget-impact analysis/cost comparison (n = 2) and cost-benefit analysis (n = 1). Most studies took the healthcare provider’s perspective. Only a few models included some wider societal costs, such as productivity loss or costs of drug-related crime, disorder and antisocial behaviour. Costs to individuals and impacts on family and social networks were not included in any model.ConclusionA relatively small number of studies of varying quality were found. Strengths and weaknesses relating to model structure, inputs and approach were identified across all the studies. There was no indication of a single standard emerging as a preferred approach. Most studies omitted societal costs, an important issue since the implications of drug abuse extend widely beyond healthcare services. Nevertheless, elements from previous models could together form a framework for future economic evaluations in opioid agonist therapy including all relevant costs and outcomes. This could more adequately support decision-making and policy development for treatment of non-prescription opioid dependence.Electronic supplementary materialThe online version of this article (doi:10.1186/s13722-017-0071-3) contains supplementary material, which is available to authorized users.

Evidence on the Effectiveness of Heroin-Assisted Treatment

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Use of opioid substitution therapies in the treatment of opioid use disorder: results of a UK cost-effectiveness modelling study

“…We consider the development of the model a step forward in providing researchers a methodology for testing the cost-effectiveness of OST formulations. However, further work is required to develop the model fully, principally due to the limited data in this area 9 . Additionally, future models should include a more comprehensive consideration of the economic and societal consequences (including victim costs) of heroin use 9 .…”

“…This may require the development of health economic models. A recent systematic review of economic models that have been used in appraising OST revealed a limited number of models in the peer-reviewed literature, and no clear consensus to modeling approaches 9 . To explore this area further, we replicated an existing health technology assessment (HTA) model developed by Connock et al 10 , and updated the model using 2016 costs.…”

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