Clinical impact, costs, and cost-effectiveness of hospital-based strategies for addressing the US opioid epidemic: a modelling study

Abstract

BackgroundThe syndemic of injection drug use and serious injection-related infections is leading to increasing mortality in the USA. Although outpatient treatment with medications for opioid use disorder reduces overdose risk and recurrent infections, hospitalisation remains common. We evaluated the clinical impact, costs, and costeffectiveness of hospital-based strategies to address the US opioid epidemic. MethodsWe developed a microsimulation model to compare the cost-effectiveness of: standard hospital caredetoxification for opioids, no addiction consult service (status quo); expanded inpatient prescribing of medications for opioid use disorder, including bridge prescriptions (ie, medication until they can see an outpatient provider) when possible (medications for opioid use disorder with bridge); implementation of addiction consult services within the hospital (addiction consult services alone); and a combined medication for opioid use disorder with addiction consult services strategy (combined). We used clinical trials and observational cohorts to inform model inputs. Outcomes were life-years, discounted costs, incremental cost-effectiveness ratios, hospitalisations, and deaths. We did deterministic sensitivity analyses on key model inputs related to costs and sequelae of drug use and probabilistic sensitivity analysis to further address uncertainty. Findings Among people who inject opioids in the USA, we estimated that expanding medications for opioid use disorder with bridge prescriptions would reduce hospitalisations and overdose deaths by 3•2% and 3•6%, respectively, and the combination of expanded medications with opioid use disorder along with addiction consult sevices would reduce hospitalisations and overdoses by 5•2% and 6•6%, respectively, compared with the status quo. Mean lifetime costs ranged from US$731 400 (95% credible interval 447 911-859 189 for the medications for opioid use disorder strategy) to $741 200 (470 930-868 551 for the combined strategy) per person. Assuming a willingness-to-pay threshold of $100 000 per life-year gained, medications for opioid use disorder with bridge and combined strategies were cost-effective ($7600 and $14 300, respectively). A scenario that assumed ideal access to harm reduction services came to the same conclusions as the base case and our results were robust in deterministic and probabilistic sensitivity analyses.Interpretation The combined interventions of expanding hospital-based prescribing of medications for opioid use disorder and implementing addiction consult services could improve life expectancy, be cost-effective, and could be the basis for a comprehensive hospital-based strategy for addressing the opioid epidemic in the USA and countries with similar opioid epidemics.

Impact of Status quo and Resistance to Innovation on the Failure of Detection and Prevention Strategies of Drugs Control Committee in Malaysia

“…Because the SQ members are not active in the motivation process of drug-addicted individuals, that is the reason for the failure of their detection and prevention strategies to control the drugaddicted people. This finding is also the same as the findings of Barocas et al (2022) which also examined that the members who are SQ in nature are not active in their operations and are considered very lazy in adopting and implementing new strategies, which is the reason of the failure of their detection and prevention strategies to control the drug-addicted people.…”

“…Because the SQ members are not active in the motivation process of drug-addicted individuals, that is the reason for the failure of their detection and prevention strategies to control the drug-addicted people. This finding is also the same as the findings of Barocas et al (2022) which also examined that the members who are SQ in nature are not active in their operations and are considered very lazy in adopting and implementing new strategies, which is the reason of the failure of their detection and prevention strategies to control the drug-addicted people. The article results related to the SQ nature of the committee have a positive impact on the failure of drug control committee strategies, and this result is matched with the study by Del Pozo and Beletsky (2020) which also exposed that if the nature of the committee was SQ, then it leads toward the failure of drug control committee strategies in the country.…”

Integration of a community-based harm reduction program into a safety net hospital: a qualitative study

“…Inpatient addiction consult services are also able to start medications for opioid use disorder as well as link patients to outpatient care [ 14 ]. Modeling studies suggest that addiction consult services are cost-effective while also saving lives [ 15 ].…”

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

“…Our findings also reinforce the importance of addiction care services and contribute to increasing evidence suggesting the necessity of addiction care services for the treatment of individuals with opioid use disorder. 18 Concerns regarding the efficacy of oral antibiotic medications have hindered efforts to expand the use of partial oral antibiotic therapy for the treatment of IDU-IE. Within our main analysis, we assumed that patients with MRSA-associated IDU-IE were ineligible to receive partial oral antibiotic therapy but that otherwise the modeled antibiotic therapies had similar treatment completion rates if the treatment course was completed.…”