Measuring benefits of opioid misuse treatment for economic evaluation: health‐related quality of life of opioid‐dependent individuals and their spouses as assessed by a sample of the US population

Abstract

Aims To understand how the general public views the quality of life effects of opioid misuse and opioid use disorder on an individual and his/her spouse, measured in terms used in economic evaluations. Design Cross-sectional internet survey of a US-population-representative respondent panel conducted December 2013-January 2014. Setting USA. Participants 2,054 randomly-selected adults; 51% male (before weighting). Measurements Mean (95% CI) and median health “utility” for 6 opioid misuse and treatment outcomes: active injection misuse; active prescription misuse; methadone maintenance therapy at initiation, and when stabilized in treatment; and buprenorphine therapy at initiation, and when stabilized. Utility is a numerical representation of health-related quality of life used in economic evaluations to “adjust” estimated survival to include peoples' preferences for health states. Utilities are determined by surveying the general population to estimate the value they assign to particular health states—on a scale where 0=the value of being dead, and 1.0=the value of being in perfect health. Spouse spillover utility is assigned to a spouse of an individual who is in a particular health state. Findings Mean individual utility ranged from 0.574 (95%CI: 0.538, 0.611) for active injection opioid misuse to 0.766 for stabilized buprenorphine therapy (95%CI: 0.738, 0.795), with other states in between. Female respondents assigned higher utility to the active prescription misuse and buprenorphine therapy at initiation states than did males (p<0.05); all other states did not differ by respondent gender. Mean spousal utilities were significantly lower than 1.0 but mostly higher than individual utility, and were similar between male and female respondents. Conclusions In the opinion of the US public, injection opioid misuse results in worse health-related quality of life than prescription misuse, and methadone therapy results in worse health-related quality of life than buprenorphine therapy. Spouses are negatively affected by their partner's opioid misuse and early treatment.

The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013

“…In this case, there are many costs we were unable to measure, such as the reduction in quality of life of those who are dependent. These impacts are substantial, with a previous study finding a quality adjusted life year reduction of approximately 50% (26). We also cannot account for the pain and suffering of family members who have lost loved ones due to fatal overdoses.…”

Cost‐effectiveness of scaling‐up HCV prevention and treatment in the United States for people who inject drugs

“…(5.1) We assessed the impact of using lower utility values, as reported in Wittenberg et al . , for PWID not in MAT (0.574 instead of base‐case 0.8) and PWID in MAT (0.722 instead of base‐case 0.9). (5.2) We also assessed the impact of using the minimum quality of life (QoL) estimator with our baseline utility values, which assigns the lower individual value of multiple co‐morbid conditions in this population .…”

Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs

“…We evaluated the impact of two alternative scenarios on our results. First, we considered whether the quality-of-life impact of HCV treatment might differ for individuals in methadone maintenance treatment, whose overall quality of life is rated lower than that of individuals in the general population (Wittenberg et al, 2016). In an alternative scenario, we applied the minimum quality of life estimator, which may be a more accurate assessment of quality of life for multiple co-morbid conditions in this population (Wittenberg et al, 2017).…”