Evaluation of Prescription Opioid Use Prevention Programs

"Four studies evaluated the cost-effectiveness of prescription opioid misuse prevention, three of which were conducted in the USA and one in South Korea. The interventions identified for the USA setting were a school-based programme, a family-centred programme and misuse-deterrent opioid formulations; a doctor's database assisting patient risk assessment was evaluated in the South Korean setting. All four studies utilised economic models to evaluate cost and benefit of intervention over 1- to 30-year time horizons.

"Two of the studies evaluated misuse-deterrent opioid formulations against extended-release opioids. White et alReference White, Birnbaum, Rothman and Katz31 conducted a CBA with a third-party payer perspective (i.e. private insurance), using a 1-year time horizon; Kumar et alReference Kumar, Agboola, Synnott, Segel, Webb and Ollendorf27 conducted a CEA considering a health sector perspective with a 5-year time horizon. Both studies included direct costs related to healthcare utilisation.Reference Kumar, Agboola, Synnott, Segel, Webb and Ollendorf27 The White et alReference White, Birnbaum, Rothman and Katz31 budget impact model estimated that there were potential cost-savings ranging from US$0.748 to US$2 billion for the insurance payer; however, the misuse-deterrent opioid prescription cost used in the study was a shadow cost or a similar cost of a branded opioid. In contrast, the misuse-deterrent opioid prescription costs used by Kumar et alReference Kumar, Agboola, Synnott, Segel, Webb and Ollendorf27 were actual drug costs that resulted in significant costs to the healthcare system. Sensitivity analysis indicated that the model was sensitive to misuse-deterrent opioid price, where a 40% reduction in misuse-deterrent opioid prescription cost would result in cost neutrality.

"The study by Crowley et alReference Crowley, Jones, Coffman and Greenberg21 evaluated youth school-based programmes, a family-centred programme or a combination of both, and compared them with having no programme over a 6-year time horizon. Only intervention delivery costs were included in the analysis. A willingness-to-pay (WTP) threshold of US$8667 per case of non-medical opioid misuse prevented was established based on the average societal cost for youth engaged in nonmedical prescription opioid use. Three sets of interventions (Life Skills Training (LST) programme only, Strengthening Families Program 10–14 (SFP:10–14) + All Stars programme and SFP:10–14 + LST) were deemed to be cost-effective, given that the ICER fell below the predetermined WTP threshold of US$8667 to prevent one youth from misusing prescription opioids before the 12th grade.Reference Crowley, Jones, Coffman and Greenberg21

"The South Korean study by Kim et alReference Kim, Kim and Suh25 evaluated an opioid abuse preventive programme, ‘the Network System to Prevent Doctor-Shopping for Narcotics’, which allows doctors access to a database of a patient's previous narcotics use, allowing them to determine if a patient is at risk of misusing narcotics. Over a 30-year time horizon, compared with no programme, implementing the programme was determined to be cost-effective (US$227 per QALY; WTP threshold of US$31 362 per QALY) from a healthcare system perspective. Threshold analysis showed that the programme was 100% cost-effective even when using a WTP threshold of US$900 per QALY. Furthermore, including cost beyond the healthcare system under a societal perspective indicated that the intervention was cost-saving against having no programme.Reference Kim, Kim and Suh25 "