Economic Evaluation in Opioid Modeling: Systematic Review

Abstract

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.

Community Distribution of Naloxone: A Systematic Review of Economic Evaluations

“…Both Mueller et al [13] and Chao and Loshak [12] focused mainly on effectiveness but concluded that community distribution of naloxone was cost effective based on the limited studies included in their reviews. Most recently, Beaulieu et al [14] performed a systematic review of model-based cost-effectiveness studies for a variety of interventions to address opioid use disorder, one of which was distribution of naloxone to laypeople. They concluded that community distribution of naloxone was cost effective.…”

“…Trialbased cost-effectiveness studies are useful in verifying in realworld contexts the assumptions made in models. Additionally, our review updates the search of the literature by about a year and conducts a more thorough critical appraisal [14].…”

Using Economic Evaluation to Inform Responses to the Opioid Epidemic in the United States: Challenges and Suggestions for Future Research

“…Medicaid government assistance programs that fund health care coverage for eligible low-income individuals and vary from state to state, could benefit substantially from economic evaluations given the considerable population health and financial burden that the treatment of OUD and co-occurring mental health disorders places upon them ( Leslie et al, 2019 ). However, to date, only a handful of studies have explicitly sought to investigate the cost-effectiveness of OUD interventions from the perspective of a state Medicaid program ( Beaulieu et al, 2021 ; Onuoha et al, 2021 ). In addition to state Medicaid programs, local health departments (LHDs), which are responsible for surveillance and prevention activities, play a crucial role in responding to opioid use and overdose within their own communities (often at county-level) ( Evans et al, 2019 ).…”

“…Between 2011 and 2016, caseloads involving the children and adolescents whose parents were affected by OUD were estimated to cost the US Child Welfare $2.8 billion ( Crowley et al, 2019 ). Existing studies in OUD illustrate that non-health costs can be incorporated in economic evaluations ( Beaulieu et al, 2021 ; Onuoha et al, 2021 ). However, these studies have tended to aggregate health and non-health costs which can be misleading for decision makers aiming to make optimal use of health care budgets if there is no scope for compensation from other sectors benefiting from a given reimbursement decision.…”

Healthcare Utilization of Patients with Opioid Use Disorder in US Hospitals from 2016 to 2019: Focusing on Racial and Regional Variances

“…Looking at the nationwide effects of the opioid crisis in the US, opioid illness between 2015 and 2018 cost the nation US$631 billion [ 6 ], and in 2018 cost US$93 billion to taxpayers [ 7 ]. Previous research has demonstrated the increased costs of an opioid use disorder, ranging from monetary to societal burdens like increased healthcare costs, criminal activity, and decreased productivity [ 7 ].…”