Expanded access to medication-assisted treatment (MAT) for individuals with opioid use disorder (OUD) should be considered as it was associated with cost-saving reductions in mortality, according to results of a cost-effectiveness analysis published in JAMA Psychiatry.
Researchers from Stanford University analyzed data from Veterans Affairs and public databases. MAT was defined as baseline counseling and medication services (buprenorphine, methadone, or extended-release naltrexone). Various treatment options for OUD were assessed for quality-adjusted life-years (QALYs).
Among a cohort of 100,000 individuals with OUD who did not receive treatment, 42,717 overdoses and 12,660 deaths occurred over 5 years. These values equated to 11.58 fewer QALYs per person.
Methadone treatment was associated with a 10.7% decrease in overdoses and a 6.0% decrease in mortality. Buprenorphine or naltrexone decreased overdoses by 22.0% and mortality by 13.9%. Combining MAT with contingency management (CM) and psychotherapy reduced overdoses by 21.0% with methadone, 31.2% with buprenorphine, and 31.4% for naltrexone. Combining MAT with CM, psychotherapy, and overdose education and naloxone distribution (OEND) decreased deaths by 16.9% with methadone and 23.7% with buprenorphine or naltrexone.
OEND alone decreased fatal overdoses by 17.8% but increased overall overdoses from 42,717 to 42,895.
Compared with no treatment, per-person QALYs increased by 0.22 for OEND, 1.02-1.07 for MAT alone, and 1.7 for MAT combined with CM, psychotherapy, and OEND. The most costly strategy was buprenorphine with CM, psychotherapy, and OEND, which equated to a $250,000/QALY gained. The most cost-effective strategy was methadone alone ($16,000/QALY gained).
Combined with criminal justice costs, the per-person net savings were $100,000 for methadone, $60,000 for buprenorphine, and $40,000 for naltrexone.
In a sensitivity analysis, the investigators observed that in order to be a cost saving treatment, methadone needed to reduce criminal justice costs by ³10%, buprenorphine by ³23%, and naltrexone by ³42%. With a willingness to pay $100,000/QALY gained, methadone with CM and OEND was superior among 67% of models.
This study may have been limited by not including costs due to lost productivity, social services, or housing.
These data indicated MAT with or without CM, psychotherapy, and OEND was cost effective for the treatment of OUD.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Fairley M, Humphreys K, Joyce VR, et al. Cost-effectiveness of treatments for opioid use disorder. JAMA Psychiatry. Published online March 31, 2021. doi:10.1001/jamapsychiatry.2021.0247