Re-engineering methadone—Cost-effectiveness analysis of a patient-centered approach to methadone treatment

Treatment of opioid use disorder in primary care

“…117 Patients in the patient centered methadone arm attended fewer group counseling services (P>0.05) but similar numbers of individual counseling sessions. 117 A cohort study of 217 patients attending a methadone program who transitioned to a patient centered model found no significant differences in two year treatment retention or in opioid or benzodiazepine use between cohorts initiated before, during, and after transition to patient centered treatment. 115 Although counseling became voluntary with patient centered methadone, the number of therapist visits did not change significantly between pre-transition and post-transition cohorts.…”

“…[115][116][117] An RCT of 300 patients starting methadone compared patient centered methadone with treatment as usual and found no significant differences in treatment retention, measures of opioid use, other patient outcomes, or cost (P=0.49). 117 Patients in the patient centered methadone arm attended fewer group counseling services (P>0.05) but similar numbers of individual counseling sessions. 117 A cohort study of 217 patients attending a methadone program who transitioned to a patient centered model found no significant differences in two year treatment retention or in opioid or benzodiazepine use between cohorts initiated before, during, and after transition to patient centered treatment.…”

“…Many primary care based models partner with community pharmacies to allow for supervised dosing of methadone; this can be a practical way to expand treatment in rural settings and was feasible in two US based pilot studies 113114. Additionally, patient centered methadone treatment models (where counseling is optional, patients are involved in treatment decisions, dose limits are removed, and the focus on abstinence is less) have been shown to be clinically effective and cost effective across multiple studies 115116117. An RCT of 300 patients starting methadone compared patient centered methadone with treatment as usual and found no significant differences in treatment retention, measures of opioid use, other patient outcomes, or cost (P=0.49) 117.…”

Health economic design for cost, cost-effectiveness and simulation analyses in the HEALing Communities Study

“…For example, we will have records of who attended coalition meetings and how long those meetings last even if a participant did not complete a coalition meeting survey. Finally, we will use model-based imputation (including multiple imputation when appropriate) and sensitivity analyses to account for missing data, sampling variability, and other sources of uncertainty ( Briggs et al, 2003 ; Dunlap et al, 2018 ; Faria et al, 2014 ; Michalowsky et al, 2020 ). These methods will be conducted within the broader cost-effectiveness analysis described below.…”

“…The individual ORCCA EBP components of CTH have a substantial literature assessing their costs and cost-effectiveness. For instance, the cost-effectiveness of MOUD has an established evidence base across a variety of settings and populations, particularly for methadone maintenance therapy and buprenorphine ( Barocas et al, 2019 ; Busch et al, 2017 ; Dunlap et al, 2018 ; Gisev et al, 2015 ; Krebs et al, 2018 ; Murphy et al, 2019 ; Murphy and Polsky, 2016 ). Additionally, programs providing naloxone to high-risk individuals and first responders for reducing opioid overdose mortality have also been found cost-effective ( Coffin and Sullivan, 2013 ; Townsend et al, 2020 ).…”