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

In this systematic review, researchers affiliated with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) including CHERISH staff Erica Onuoha and Jared Leff; CHERISH investigators Bruce R. Schackman, Kathryn E. McCollister, and Sean M. Murphy; and CHERISH Advisory Board member Daniel Polsky, identified new studies supporting buprenorphine and methadone as economically advantageous medications for people with opioid use disorder. This paper builds on a previous literature review published by Murphy and Polsky in 2016. Both reviews seek to inform policymakers and healthcare providers about the economic value of three FDA-approved treatments for opioid use: methadone, buprenorphine, and injectable extended-release naltrexone.

The authors screened a total of 3,247 scientific papers published between 2015 and 2019. They utilized Murphy and Polsky’s inclusion criteria from their 2016 literature review, identified a total of 21 articles that assessed the economic value of interventions for opioid use disorder, and evaluated the quality of these articles based on the Drummond checklist. After reviewing the 21 articles, the authors found:

• Potential reductions in overall healthcare costs for individuals treated with medications for opioid use disorder compared to no medication.
• Limited data evaluating the economic value of injectable extended-release naltrexone.
• Wide variation in disease/disorder-specific measures that limited comparisons across economic evaluations and the substance use disorder literature.

Of the 11 articles that reported comparable cost-effectiveness measures (quality-adjusted life-year or disability-adjusted life-year):

• Three studies that compared buprenorphine to no medication treatment showed that buprenorphine was favored depending on a stakeholder’s willingness-to-pay threshold.
• Six studies support buprenorphine and methadone as economically valuable treatments compared to no medication.
• Two studies that compared methadone to buprenorphine had distinct results. One found that methadone is preferred but results were sensitive to cost of methadone. The other study found that buprenorphine is preferred.

The opioid crisis is estimated to cost the United States $787 billion in 2018 dollars annually. The authors conclude that while no one medication for opioid use disorder is economically superior, there is growing evidence that medications like buprenorphine and methadone address the economic burden on a national and population level. Further research on the economic value of injectable extended-release naltrexone and emerging treatments for opioid use disorder are also encouraged to provide a comprehensive assessment of treatment options.