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Cost analysis backs immediate access to agonist drugs for opioid dependence

November 29, 2017

A new cost-effectiveness study published this month suggests that California, the state that treats the largest population of opioid-dependent individuals, would gain immensely from offering patients immediate access to agonist drug treatments in the public system.

Published online Nov. 21 in the Annals of Internal Medicine, the study states that access to maintenance treatment upon the first treatment visit would save California taxpayers more than $78,000 per patient. The projected savings are based largely on the effects of treatment retention and reduced criminal justice costs. If this approach hypothetically were to be extended to all Californians who started opioid use disorder treatment in 2014, the lifetime savings for this group could be as high as a staggering $3.8 billion, the researchers concluded.

One of the study's co-authors says the results of this cost-effectiveness analysis reinforce the need for extended treatment for the chronic disease of opioid addiction.

“The view that a brief 'detox' with opioid users is meaningful treatment has repeatedly been demonstrated to be incorrect,” says Richard A. Rawson, PhD, retired co-director of UCLA Integrated Substance Abuse Programs. “This study confirms this fact.”

The traditional practice of opioid detox hits home especially in California because, according to state regulations that are still in place, publicly insured patients there must have a demonstrated history of failure with opioid detox before the state will pay for methadone or buprenorphine treatment. Rawson clarifies, however, that “during the past five-plus years, this requirement is routinely waived. Individuals with [opioid use disorder] can be admitted to maintenance treatment without previous detox failures.”

Details of study

The Annals of Internal Medicine study, led by Emanuel Krebs of St. Paul's Hospital in Vancouver, sought to determine the cost-effectiveness of opioid agonist treatment for all treatment patients in comparison to the observed standard of care in California's publicly funded treatment system. In 2014, fewer than half of Californians receiving treatment for an opioid use disorder received methadone or buprenorphine.

The researchers accessed 2006-2010 data from publicly funded treatment and criminal justice records in the state. In their model-based analysis, they concluded that immediate access to agonist therapy resulted in a $78,257 per-patient savings and more quality-adjusted life years than the typical standard of care (medically managed withdrawal). This would amount to a lifetime savings of up to $3.8 billion based on 2014 patient data, the researchers reported.

“The value of publicly funded treatment of opioid use disorder in California is maximized when [opioid agonist treatment] is delivered to all patients presenting for treatment, providing greater health benefits and cost savings than the observed standard of care,” stated the authors of the study, which was funded by the National Institute on Drug Abuse (NIDA).

As with most cost-effectiveness studies, the conclusions ultimately lead to the question of whether policy-makers are willing to support short-term increases in treatment costs in order to incur much larger cost savings later.

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