Evaluation of the cost-utility of a prescription digital therapeutic for the treatment of opioid use disorder

Velez, Fulton; Luderer, Hilary F.; Gerwien, Robert; Parcher, Benjamin; Mezzio, Dylan; Malone, Daniel C.

doi:10.1080/00325481.2021.1884471

Cited by 10 publications

(5 citation statements)

References 29 publications

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“…Integration of digital interventions with drug-based therapies is illustrated by the FDA approval of a prescription adjunct digital therapeutic, namely reSET-O ® PDT, in conjunction with buprenorphine for opioid use disorder (OUD). This adjunct digital intervention was shown to improve therapy and health care outcomes, including cost-effectiveness ( 79 – 84 ). From the perspective of long-term therapy outcomes for chronic diseases, patients could benefit from research and development of both adjunct digital therapeutics and drug+digital combination therapies (using drug-device combination product regulatory pathway, where drug is combined with a mobile app approved as SaMD) ( 18 , 85 – 89 ).…”

Section: Discussionmentioning

confidence: 99%

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

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Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.

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Section: Discussionmentioning

confidence: 99%

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

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“…While opioid agonist treatments like methadone and buprenorphine are gold standard [ 34 ], their associated cost may limit patient acceptance and lessen their effectiveness in combating this crisis. Cost-effective options like adjunct digital therapeutics [ 35 ] and treatment cascades [ 36 ] have proven effective and should be adapted to minority populations. Our research has identified gaps in care in the Northeast, specifically the Middle Atlantic, and for Hispanic and Black patients.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Utilization of Patients with Opioid Use Disorder in US Hospitals from 2016 to 2019: Focusing on Racial and Regional Variances

2022

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Background There is a lack of US population-based research on healthcare utilization differences caused by opioid misuse. Objective The aim of this study was to explore disparities in healthcare utilization by type of opioid use disorder, race, region, and other patient factors for a more targeted prevention and treatment program. Methods The National Inpatient Sample of the United States was used to identify patients with opioid use disorder ( n = 101,231, weighted n = 506,155) from 2016 to 2019. Type of opioid use disorder was defined as opioid dependence/unspecified use, adverse effects of opioids, opioid misuse, and opioid poisoning (also known as overdose). We examined the sample characteristics and the association between type of disorder, racial and regional variables, and healthcare utilization, measured by hospital charges and length of stay. The multivariate survey linear regression model was used. Results Among 506,155 patients, most were categorized as opioid dependence/unspecified use (56.3%) and opioid poisoning (42.7%). The number of opioid use disorder patients during the study decreased; however, overall total charges and length of stay continuously increased. Survey linear results showed that opioid poisoning, adverse effects, and abuse were associated with higher hospital charges than opioid dependence; however, length of stay was significantly lower for these groups. White patients compared with minorities, and West, Northeast, and South regions were associated with higher hospital charges and length of stay. Conclusion Significant differences in healthcare utilization exist between type of disorder, race, and region. Such findings illustrate that tailored treatment regimens are required to bridge the gaps in care and combat the opioid crisis. Minorities with opioid use disorder utilize healthcare the least, possibly because of affordability, and need culturally sensitive and financially feasible treatment options.

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“…Hence, the incremental cost-effectiveness would become more favorable. The 12-week time horizon has also been studied in two other published health economic evaluations of reSET-O; the first (Wang et al, 2020) [ 31 ] evaluated the impact of adherence with reSET-O but did not include impact on health utilities and therefore could not calculate a cost/QALY outcome, while the second (Velez, et al, 2021) [ 44 ] measured health utilities and calculated a cost/QALY based on abstinence rates from the pivotal clinical trial for reSET-O. Future studies should include economic analyses and real-world evidence of the impact of reSET-O beyond 12 weeks, and beyond third-party payers, as it is likely that other public costs related to criminal activity and lost productivity also would be impacted by increasing treatment adherence through PDTs[ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of a Prescription Digital Therapeutic for the Treatment of Opioid Use Disorder

Velez

Malone²

2021

Journal of Market Access & Health Policy

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The lack of adequate treatment for many patients with opioid use disorder (OUD) has led to high medical costs ($90B in 2020). An analysis of the cost-effectiveness (cost-utility) of reSET-O, the first and only FDA-approved prescription digital therapeutic (PDT) for the treatment of OUD, is needed to inform value assessments and healthcare decision making. To evaluate the cost-utility of reSET-O in conjunction with treatment-as usual (TAU) compared to TAU alone. A third-party payer-perspective decision analytic model evaluated the cost-effectiveness of reSET-O + TAU relative to TAU (i.e., oral buprenorphine, face-to-face counseling, and contingency management [immediate rewards for negative drug tests logged]) alone over 12 weeks. Clinical effectiveness data (retention in therapy and health state utilities) were obtained from the peer-reviewed literature, while resource utilization and cost data were obtained from a published claims data analyses. Over 12 weeks, the addition of reSET-O to TAU resulted in a gain of 0.003 quality-adjusted life years (QALYs), and $1,014 lower costs, resulting in economic dominance vs. TAU. reSET-O + TAU’s was economically dominant (less costly, more effective) vs. TAU alone over 12 weeks, a result that was driven by a reduction in medical costs after initiation of reSET-O observed in a recent real-world claims analysis.

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Evaluation of the cost-utility of a prescription digital therapeutic for the treatment of opioid use disorder

Cited by 10 publications

References 29 publications

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Healthcare Utilization of Patients with Opioid Use Disorder in US Hospitals from 2016 to 2019: Focusing on Racial and Regional Variances

Cost-Effectiveness Analysis of a Prescription Digital Therapeutic for the Treatment of Opioid Use Disorder

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