Economic Evaluations of Opioid Use Disorder Interventions

Abstract

Background The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance-use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage the adoption of a given therapy, nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. Objective The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. Methods We performed a systematic review of the major electronic databases from inception until present (August 2015). A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic-evaluation studies according to their quality. Results A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n=49) were included in this study. Six of the included articles were review in nature. The remaining 43 articles performed an economic evaluation of an intervention for opioid use disorders. In general, the evidence on methadone-maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid-use-disorder therapy. The economic literature comparing MMT to other opioid-use-disorder pharmacotherapies is limited, as is the literature on other forms of therapy. Conclusions With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid-use-disorder interventions.

The costs of crime during and after publicly funded treatment for opioid use disorders: a population‐level study for the state of California

“…While a systematic review of cost-benefit and cost-effectiveness analyses for the treatment of OUD by Doran [38] found that studies published prior to 2007 which include criminal activity consistently find benefits outweighing the costs, the information on criminal justice costs was found to be limited. In a review of economic evaluations focused on estimating costs associated with treatment for OUD, Murphy & Polsky [39] found that 12 of the 13 included studies only considered costs attributable to the health-care system; the single exception reported costs of crime associated with treatment access in a Canadian setting [40]. To our knowledge, there has never been a population-level estimate of the costs of crime associated with treatment engagement for OUD compared to subsequent treatment discontinuation.…”

Business Cycles and Admissions to Substance Abuse Treatment

“…It is worthwhile to consider what type of individual is influenced by business cycle contractions into seeking, or not seeking, specialty treatment. As discussed earlier in the manuscript, specialty treatment has been found to reduce substance abuse and mitigate associated societal costs including crime, decreased labor market productivity, and healthcare use (Doran ; McCollister and French ; Murphy and Polsky ; Schori ). While our data will not allow us to fully study this question, we hypothesize that the affected group is heterogeneous.…”

Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts

“…In terms of reducing substance use, the effectiveness of SUD treatment, both outpatient and inpatient, is well documented within a broad range of patient populations (Reuter and Pollack, ; Stewart et al ., ; Swensen, ; Lu and McGuire, ; Hubbard et al ., ; Gossop et al ., ). For example, medication‐assisted treatment for opioid use disorder has been shown to reduce opioid use among patients (Murphy and Polsky, ; Ball and Ross, ; Schackman et al ., ), brief screening interventions can reduce alcohol use among patients presenting at emergency rooms (Kunz et al ., ), physician advice can help older adults reduce problematic drinking (Mundt et al ., ), and treatment programs that address the unique characteristics of women with SUDs can reduce substance use within this population (Ashley et al ., ; French et al ., ).…”