Emanuel Krebs, MA; Benjamin Enns, MA; Elizabeth Evans, PhD; Darren Urada, PhD; M. Douglas Anglin, PhD; Richard A. Rawson, PhD; Yih-Ing Hser, PhD; Bohdan Nosyk, PhD
Acknowledgment: The authors thank Daphne Guh and Nick Bansback for their work developing the initial version of the model.
Grant Support: By grants R01DA031727 (Dr. Nosyk), R01DA032551 (Dr. Nosyk), and P30DA016383 (Dr. Hser) from the National Institute on Drug Abuse. The funding agreement ensured the authors' independence in designing the study, interpreting the data, and writing and publishing the report.
Disclosures: Dr. Urada reports that his institution has an evaluation contract with the California Department of Health Care Services that supported data analysis during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0611.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not applicable. Statistical code: Additional detail can be made available where the Supplement is insufficient by contacting Bohdan Nosyk (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Bohdan Nosyk, PhD, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; e-mail, email@example.com.
Current Author Addresses: Mr. Krebs, Mr. Enns, and Dr. Nosyk: BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Dr. Evans: School of Public Health and Health Sciences, University of Massachusetts Amherst, 311 Arnold House, 715 North Pleasant Street, Amherst, MA 01003.
Drs. Urada, Anglin, and Hser: UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025.
Dr. Rawson: 1952 Route 73, Brandon, VT 05733.
Author Contributions: Conception and design: E. Krebs, M.D. Anglin, B. Nosyk.
Analysis and interpretation of the data: E. Krebs, B. Enns, E. Evans, D. Urada, B. Nosyk.
Drafting of the article: E. Krebs, B. Enns, E. Evans, R.A. Rawson, B. Nosyk.
Critical revision of the article for important intellectual content: B. Enns, E. Evans, D. Urada, M.D. Anglin, R.A. Rawson, B. Nosyk.
Final approval of the article: E. Krebs, B. Enns, E. Evans, D. Urada, M.D. Anglin, R.A. Rawson, Y.I. Hser, B. Nosyk.
Provision of study materials or patients: E. Evans, Y.I. Hser, B. Nosyk.
Statistical expertise: E. Krebs, B. Nosyk.
Obtaining of funding: D. Urada, M.D. Anglin, Y.I. Hser, B. Nosyk.
Administrative, technical, or logistic support: B. Enns, E. Evans, Y.I. Hser.
Collection and assembly of data: B. Enns, E. Evans, D. Urada, Y.I. Hser, B. Nosyk.
Only 1 in 5 of the nearly 2.4 million Americans with an opioid use disorder received treatment in 2015. Fewer than half of Californians who received treatment in 2014 received opioid agonist treatment (OAT), and regulations for admission to OAT in California are more stringent than federal regulations.
To determine the cost-effectiveness of OAT for all treatment recipients compared with the observed standard of care for patients presenting with opioid use disorder to California's publicly funded treatment facilities.
Model-based cost-effectiveness analysis.
Linked population-level administrative databases capturing treatment and criminal justice records for California (2006 to 2010); published literature.
Persons initially presenting for publicly funded treatment of opioid use disorder.
Immediate access to OAT with methadone for all treatment recipients compared with the observed standard of care (54.3% initiate opioid use disorder treatment with medically managed withdrawal).
Discounted quality-adjusted life-years (QALYs) and discounted costs.
Immediate access to OAT for all treatment recipients costs less (by $78 257), with patients accumulating more QALYs (by 0.42) than with the observed standard of care. In a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, total lifetime savings for this cohort could be as high as $3.8 billion.
99.6% of the 2000 simulations resulted in lower costs and more QALYs.
Nonrandomized delivery of OAT or medically managed withdrawal.
The value of publicly funded treatment of opioid use disorder in California is maximized when OAT is delivered to all patients presenting for treatment, providing greater health benefits and cost savings than the observed standard of care.
National Institute on Drug Abuse.
Krebs E, Enns B, Evans E, Urada D, Anglin MD, Rawson RA, et al. Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Ann Intern Med. [Epub ahead of print 21 November 2017]168:10–19. doi: 10.7326/M17-0611
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Published: Ann Intern Med. 2018;168(1):10-19.
Published at www.annals.org on 21 November 2017
Healthcare Delivery and Policy, Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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