Economic Evaluations of Pharmacologic Treatment for Opioid Use Disorder: A Systematic Literature Review

Abstract

Objective: The crisis of opioid use puts a strain on resources in the United States and worldwide. There are 3 US Food and Drug Administration-approved medications for treatment of opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone (XR-NTX). The comparative effectiveness and cost vary considerably among these 3 medications. Economic evaluations provide evidence that help stakeholders efficiently allocate scarce resources. Our objective was to summarize recent health economic evidence of pharmacologic treatment of opioid use disorder interventions.

Methods: We searched PubMed for peer-reviewed studies in English from August 2015 through December 2019 as an update to a 2015 review. We used the Drummond checklist to evaluate and categorize economic evaluation study quality. We summarized results by economic evaluation methodology and pharmacologic treatment modality.

Results: We identified 105 articles as potentially relevant and included 21 (4 cost-offset studies and 17 cost-effectiveness/cost-benefit studies). We found strengthened evidence on buprenorphine and methadone, indicating that these treatments are economically advantageous compared with no pharmacotherapy, but found limited evidence on XR-NTX. Only half of the cost-effectiveness studies used a generic preference-based measure of effectiveness, limiting broad comparison across diseases/disorders. The disease/disorder-specific cost-effectiveness measures vary widely, suggesting a lack of consensus on the value of substance use disorder treatment.

Conclusion: We found studies that provide new evidence supporting the cost-effectiveness of buprenorphine compared with no pharmacotherapy. We found a lack of evidence supporting superior economic value for buprenorphine versus methadone, suggesting that both are attractive alternatives. Further economic research is needed on XR-NTX, as well as other emerging pharmacotherapies, treatment modalities, and dosage forms.

Keywords: cost offset; cost-benefit analysis; cost-effectiveness analysis; healthcare utilization; opioid use disorder; systematic review.

Figure 1:

Article selection process. OUD = opioid use disorder.

Figure 2:

Number of published economic evaluations of medication to treat OUD (2007 – 2019). *3 of 4 publications in 2015 are summarized in Murphy & Polsky review; 1 of 4 publications from 2015 are in included in this review.

Figure 3.

Results Venn diagram economic evaluation are OUD interventions. OUD = opioid use disorder; XR-NTX = injectable naltrexone