Expanded medication-assisted treatment significantly cost effective for opioid abuse
A substantial proportion of people with opioid use disorder in the United States have not received any form of medication-assisted treatment, according to results of a model-based cost-effectiveness analysis published in JAMA Psychiatry.
Expanded access to medication-assisted treatment combined with other interventions may lead to cost-saving reductions in morbidity and mortality from opioid use disorder, researchers found.
“Although some studies have assessed the effectiveness and cost-effectiveness of various interventions to treat [opioid use disorder], no study has examined the effect and cost effectiveness of specific forms of medication-assisted treatment (MAT) (with methadone, buprenorphine, or extended-release naltrexone) with combinations of potential add-on treatments (eg, contingency management), to our knowledge,” Michael Fairley, PhD, of the department of management science and engineering at Stanford University’s Huang Engineering Center, and colleagues wrote. “Moreover, many prior studies evaluated treatment from a relatively narrow health care perspective without accounting for societal savings, such as those that accrue from the criminal justice system. Determining the most effective and cost-effective interventions to treat [opioid use disorder] is important because treatment resources are limited, and unmet treatment need is substantial.”
The researchers aimed to evaluate the cost-effectiveness of opioid use disorder treatments and these treatments’ role in outcomes in the U.S. Specifically, they assessed the mean number of fatal and nonfatal overdoses and total death across 5 years for 100,000 individuals with opioid use disorders, as well as their expected lifetime total costs and quality-adjusted life-years. Interventions included medication-assisted treatment with buprenorphine, methadone or injectable extended-release naltrexone; psychotherapy; overdose education and naloxone distribution; and contingency management.
Results showed an estimated 42,717 overdoses, of which 4,132 were fatal and 38,585 were nonfatal, and 12,660 deaths among the cohort across 5 years, in the absence of treatment. Moreover, the researchers reported an estimated 11.58 discounted lifetime quality-adjusted life-years per person. They observed an association between estimated reduction in overdoses and medication-assisted treatment with methadone (10.7%), as well as with buprenorphine or naltrexone (22%), and in combination with contingency management and psychotherapy for a range of 21% to 31.4%.
Estimated reductions in deaths linked to medication-assisted treatment were 6% with methadone, 13.9% with buprenorphine or naltrexone and 16.9% when combining medication-assisted treatment with contingency management, overdose education and naloxone distribution and psychotherapy. Medication-assisted treatment alone was linked to an increase in per-person quality-adjusted life-years of 1.02 to 1.07. When only health care sector costs were included, methadone cost $16,000 per quality-adjusted life-year gained vs. no treatment, followed by methadone with overdose education and naloxone distribution for $22,000 per quality-adjusted life-year gained, buprenorphine with overdose education and naloxone distribution and contingency management for $42,000 per quality-adjusted life-year gained and buprenorphine with overdose education and naloxone distribution, contingency management and psychotherapy for $250,000 per quality-adjusted life-year gained. Other treatment alternatives outperformed medication-assisted treatment with naltrexone. Upon including criminal justice costs, all forms of medication-assisted treatment were linked to cost savings vs. no treatment and yielded savings of between $25,000 and $105,000 in lifetime costs per person. Methadone plus contingency management demonstrated the largest associated cost savings.
“Policy makers and many members of Congress have proposed expanding access to [medication-assisted treatment] and [overdose education and naloxone distribution],” Fairley and colleagues wrote. “Our results indicate that such a policy, especially if it included [contingency management], would generate significant societal cost savings and, more importantly, save numerous lives.”