Building a Microsimulation Model of Heroin Use Careers in Australia

Ritter, Alison; Shukla, Nagesh; Shanahan, Marian; Phuong, Van Hoang; Cao, Vu Lam; Perez, Pascal; Farrell, Michael

doi:10.34196/ijm.00146

Cited by 5 publications

(4 citation statements)

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“…This challenge is especially present when attempting to model a population, such as people who use heroin, whose behaviors are parameterized with high uncertainty over a long time horizon. 37,47 Other cost-related challenges appeared, for instance, in measuring the quantities of drug-free therapy and detoxification services received, 37 differences in cost estimation methods between methadone and buprenorphine treatments, 42 and missing societal-relevant costs such as lost wages in the societal perspective. 47 When performed, sensitivity analyses help resolve these concerns in part by showing that varying the cost inputs did not alter the results drastically 37 -although interpretation is complicated by the lack of a standard, generally acceptable threshold of willingness to pay for some outcomes such as additional patients retained in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…37,47 Other cost-related challenges appeared, for instance, in measuring the quantities of drug-free therapy and detoxification services received, 37 differences in cost estimation methods between methadone and buprenorphine treatments, 42 and missing societal-relevant costs such as lost wages in the societal perspective. 47 When performed, sensitivity analyses help resolve these concerns in part by showing that varying the cost inputs did not alter the results drastically 37 -although interpretation is complicated by the lack of a standard, generally acceptable threshold of willingness to pay for some outcomes such as additional patients retained in treatment. 42 The topical scope of the studies covered 6 main analyses of cost-effectiveness: methadone expansion; comparisons of different medications for opioid use disorder (methadone, buprenorphine, injectable naltrexone, and, in one study, medically prescribed diacetylmorphine [ie, the active ingredient in heroin]); comparisons of modes of medication delivery (eg, sublingual vs subdermal buprenorphine-naloxone); comparisons of medications to treatment without medications; abuse-deterrent versus non-abuse-deterrent opioid prescribing; and comparisons of different naloxone distribution strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Interventions and accompanying comparators of interest included one prevention strategy (abuse-deterrent opioids), 35 treatment strategies (opioid agonist, partial agonist, or antagonist maintenance therapies), 30,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] and strategies involving naloxone distribution (distribution to laypeople; emergency medical services (EMS), police and fire workers; and secondary schools). [51][52][53][54][55] One study considered multiple sets of strategy combinations.…”

Section: Intervention and Comparatormentioning

confidence: 99%

“…Other studies analyzed health and cost impacts of the abuse-deterrent opioid prescribing decision separately rather than incrementally 35 or estimated costs over heroin use. 47 Only 1 study 41 examined injectable naltrexone and compared it with MMT or BMT, and it was considered cost-effective against MMT if policymakers were willing to pay an additional $72 per patient per opioid-free day. One study 46 examined prescribed diacetylmorphine (ie, heroin), and it was found to be cost-effective relative to MMT.…”

Section: Incremental Cost-effectiveness Ratios and Other Cost Analysis Findingsmentioning

confidence: 99%

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Economic Evaluation in Opioid Modeling: Systematic Review

et al. 2021

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The rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature.Methods: A systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. Results:The screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studies' accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. Conclusion:The review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Intervention and Comparatormentioning

confidence: 99%

Section: Incremental Cost-effectiveness Ratios and Other Cost Analysis Findingsmentioning

confidence: 99%

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Economic Evaluation in Opioid Modeling: Systematic Review

et al. 2021

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Pain Town, an Agent-Based Model of Opioid Use Trajectories in a Small Community

Bobashev

Goree

Frank

et al. 2018

Lecture Notes in Computer Science

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A Systematic Review of Simulation Models to Track and Address the Opioid Crisis

Cerdá¹,

Jalali²,

Hamilton³

et al. 2021

Epidemiologic Reviews

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The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, and nonlinear social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,398 articles screened, we identified 88 eligible articles. The most frequent types of models were compartmental (36%), Markov (20%), system dynamics (16%), and Agent-Based models (16%). Over a third evaluated intervention cost-effectiveness (40%), and another third (39%) focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (61%) discussed calibrating their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 63 studies that provided model parameters, we extracted the data sources on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality parameters. This database offers a tool that future modelers can use to identify potential model inputs and evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.

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Building a Microsimulation Model of Heroin Use Careers in Australia

Abstract: Illicit heroin use is a worldwide problem, with significant health and social costs. Treatment is known to be effective in changing heroin use habits, but it often needs to be provided over a lifetime, with people cycling in and out of treatment. It is therefore important to

Cited by 5 publications

References 55 publications

Economic Evaluation in Opioid Modeling: Systematic Review

Economic Evaluation in Opioid Modeling: Systematic Review

Pain Town, an Agent-Based Model of Opioid Use Trajectories in a Small Community

A Systematic Review of Simulation Models to Track and Address the Opioid Crisis

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