Cost per Opioid-Free Year: A Complementary Outcome Measure for Economic Evaluations
Establishing cost per opioid-free time thresholds can help stakeholders make informed resource allocation decisions.
The quality-adjusted life-year (QALY) is widely acknowledged as the standard effectiveness measure for comprehensive economic evaluations, and the only one with recognized willingness-to-pay thresholds for defining value. Recognizing the benefits of alternative effectiveness measures, Babasoji Oyemakinde, postdoctoral associate at Weill Cornell Medicine and a 2025-2026 CHERISH pilot grant recipient, is developing cost-effectiveness thresholds for the opioid-free year (OfY) as a clinical outcome measure for opioid use disorder (OUD) interventions.
Oyemakinde presented his latest findings on OfYs in the context of criminal-legal settings, as part of the 19th annual Academic Consortium on Criminal Justice Health (ACCJH) in Atlanta, Georgia. The OfY complements the QALY by operationalizing one of the clinical priorities in OUD care—reductions in opioid use—in a manner that offers a standardized, condition-specific metric for comparing the economic value of OUD interventions.
We are one step closer to defining objective thresholds specific to opioid-free time, thereby improving stakeholders’ ability to make more informed resource allocation decisions that support sustained recovery and improved long-term health trajectories.
Babasoji Oyemakinde, PhD
The incremental costs effective ratios (ICERs) summarized in his ACCJH poster set the baseline for comparing and understanding the costs of expanding OUD treatment in criminal-legal settings. Of the 336 peer-reviewed economic evaluation studies screened for his systematic literature review, only three studies met the inclusion criteria for OUD interventions in criminal-legal settings. In these criminal legal-focused studies, ICERs averaged $16,901 per OfY (healthcare-sector), $17,674 per OfY (state policymaker), and $32,125 per OfY (societal) in the U.S., while the international study reported $16,230 per OfY (healthcare-sector).
Dr. Oyemakinde noted that the ICERs developed alongside this systematic literature review will provide valuable context for future economic evaluations; in particular, those occurring within the Justice Community Overdose Innovation Network (JCOIN), an NIH/NIDA-funded research consortium dedicated to implementing, improving, and sustaining access to substance use disorder care within the criminal-legal system. Oyemakinde, an investigator in the JCOIN 2.0 Criminal-Legal Economic Analysis & Resource Center (CLEAR; U24DA064506), emphasized that JCOIN research will vastly improve decision-makers’ ability to allocate their limited resources more effectively.
“We are working with multiple JCOIN studies to incorporate opioid-free years into the economic evaluation, alongside traditional measures like the QALY. Adding this alternative benchmark will increase the economic evidence base available to decision-makers looking to expand access to SUD care within criminal-legal settings,” he adds.
The poster, “Cost per Opioid-Free Year: A Systematic Review and Summary Analysis,” was accepted to the 19th annual Academic Consortium on Criminal Justice Health (ACCJH), which took place in Atlanta, GA, from March 16-18, 2026. Co-authors include CHERISH Methodology Core Co-director Ali Jalali, CHERISH Director Sean M. Murphy, Danielle Ryan, Techna Cadet, Tyler Judge, and Manesh Gopaldas.