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. 2024 Mar 1:256:111112.
doi: 10.1016/j.drugalcdep.2024.111112. Epub 2024 Feb 1.

Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis

Gary Qian  1 , Keith Humphreys  2 , Jeremy D Goldhaber-Fiebert  3 , Margaret L Brandeau  4
Affiliations

Estimated effectiveness and cost-effectiveness of opioid use disorder treatment under proposed U.S. regulatory relaxations: A model-based analysis

Gary Qian et al. Drug Alcohol Depend. .

Abstract

Aim: To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM).

Design setting and participants: Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM).

Intervention: Buprenorphine and methadone treatment under NPRM.

Measurements: Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs.

Findings: For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment.

Conclusions: Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk.

Keywords: Buprenorphine treatment; Cost-effectiveness analysis; Dynamic compartmental model; Methadone treatment; Opioid use disorder; Simulation.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Cost-effectiveness planes a. Buprenorphine treatment b. Methadone treatment
See this image and copyright information in PMC

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