Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids.
Cost-effectiveness of Increasing Buprenorphine Treatment Initiation, Duration, and Capacity Among Individuals Who Use Opioids.
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DOI：
10.1001/jamahealthforum.2023.1080
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发表时间：
2023-05-05
期刊：
影响因子：
--
通讯作者：
Jalali MS
中科院分区：
文献类型：
--
作者：
Claypool AL;DiGennaro C;Russell WA;Yildirim MF;Zhang AF;Reid Z;Stringfellow EJ;Bearnot B;Schackman BR;Humphreys K;Jalali MS
增加丁丙诺啡治疗起始时间、持续时间和治疗阿片类药物使用障碍能力的干预措施是否具有成本效益？在对旨在增加丁丙诺啡治疗起始时间、持续时间和容量的建模干预措施的质量和经济评估中，我们预测了 5 种干预措施及其组合的健康结果和成本。这项研究发现，一系列干预措施，包括应急管理、中心辐射型临床医生培训、在急诊科开始丁丙诺啡治疗以及远程医疗，是一系列普遍接受的支付意愿阈值的首选策略。这项研究的结果表明，增加丁丙诺啡治疗持续时间和治疗能力的干预措施是最具成本效益的，并且与减少过量死亡的相关性最大。丁丙诺啡是一种治疗阿片类药物使用障碍 (OUD) 的有效且经济有效的药物，但在美国，许多 OUD 患者并不容易获得。目前的成本效益文献并未考虑同时增加丁丙诺啡起始时间、持续时间和容量的干预措施。进行成本效益分析并比较与增加丁丙诺啡治疗起始时间、持续时间和容量相关的干预措施。这项研究使用 SOURCE 对 5 种干预措施的单独和组合效果进行了建模，SOURCE 是处方阿片类药物和非法阿片类药物使用、治疗和缓解的最新系统动力学模型，根据 1999 年至 2020 年的美国数据进行校准。该分析在 2021 年至 2032 年的 12 年时间范围内进行，并进行终生随访。对干预效果和成本进行了概率敏感性分析。分析于 2021 年 4 月至 2023 年 3 月期间进行。建模参与者包括美国阿片类药物滥用和 OUD 患者。干预措施包括急诊科启动丁丙诺啡、应急管理、心理治疗、远程医疗以及扩大中心辐射型麻醉治疗计划（单独或组合）。全国阿片类药物过量死亡总数、获得的质量调整生命年 (QALY) 以及从社会和医疗保健角度来看的成本。预测显示，扩大应急管理将在 12 年内避免 3530 例阿片类药物过量死亡，比任何其他单一干预策略都要多。在没有扩大治疗能力的情况下，最初增加丁丙诺啡治疗持续时间的干预措施与阿片类药物过量死亡人数增加有关。每获得 QALY 的增量成本效益比为 19 381 美元（2021 美元），扩大应急管理、中心辐射型培训、急诊科启动和远程医疗的策略是任何支付意愿门槛从 20 000 美元到 200 000 美元/QALY 增益的首选策略，因为它与同时增加治疗持续时间和容量相关。该模型分析模拟了在丁丙诺啡级联护理中实施多种干预策略的效果，发现与增加丁丙诺啡治疗起始时间、持续时间和容量同时相关的策略具有成本效益。这项经济评估研究包括成本效益分析，并比较了与增加丁丙诺啡治疗起始时间、持续时间和容量相关的干预措施。
Are interventions to increase buprenorphine treatment initiation, duration, and capacity for treating opioid use disorder cost-effective? In this quality and economic evaluation of modeled interventions to increase buprenorphine treatment initiation, duration, and capacity, we projected health outcomes and costs of 5 interventions and their combinations. This study found that a portfolio of interventions, including contingency management, hub-and-spoke clinician training, initiation of buprenorphine treatment in the emergency department, and telehealth, was the preferred strategy for a range of generally accepted willingness-to-pay thresholds. The findings of this study suggest that interventions that increase buprenorphine treatment duration concurrently with treatment capacity are the most cost-effective and have the largest association with reducing overdose deaths. Buprenorphine is an effective and cost-effective medication to treat opioid use disorder (OUD), but is not readily available to many people with OUD in the US. The current cost-effectiveness literature does not consider interventions that concurrently increase buprenorphine initiation, duration, and capacity. To conduct a cost-effectiveness analysis and compare interventions associated with increased buprenorphine treatment initiation, duration, and capacity. This study modeled the effects of 5 interventions individually and in combination using SOURCE, a recent system dynamics model of prescription opioid and illicit opioid use, treatment, and remission, calibrated to US data from 1999 to 2020. The analysis was run during a 12-year time horizon from 2021 to 2032, with lifetime follow-up. A probabilistic sensitivity analysis on intervention effectiveness and costs was conducted. Analyses were performed from April 2021 through March 2023. Modeled participants included people with opioid misuse and OUD in the US. Interventions included emergency department buprenorphine initiation, contingency management, psychotherapy, telehealth, and expansion of hub-and-spoke narcotic treatment programs, individually and in combination. Total national opioid overdose deaths, quality-adjusted life years (QALYs) gained, and costs from the societal and health care perspective. Projections showed that contingency management expansion would avert 3530 opioid overdose deaths over 12 years, more than any other single-intervention strategy. Interventions that increased buprenorphine treatment duration initially were associated with an increased number of opioid overdose deaths in the absence of expanded treatment capacity. With an incremental cost- effectiveness ratio of $19 381 per QALY gained (2021 USD), the strategy that expanded contingency management, hub-and-spoke training, emergency department initiation, and telehealth was the preferred strategy for any willingness-to-pay threshold from $20 000 to $200 000/QALY gained, as it was associated with increased treatment duration and capacity simultaneously. This modeling analysis simulated the effects of implementing several intervention strategies across the buprenorphine cascade of care and found that strategies that were concurrently associated with increased buprenorphine treatment initiation, duration, and capacity were cost-effective. This economic evaluation study includes a cost-effectiveness analysis and compares interventions associated with increased buprenorphine treatment initiation, duration, and capacity.
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DOI：
10.1016/j.jemermed.2021.04.007
发表时间：
2021-09
期刊：
The Journal of emergency medicine
影响因子：
--
作者：
Jennings LK;Lane S;McCauley J;Moreland A;Hartwell K;Haynes L;Barth KS;Gainey SS;Brady KT
通讯作者：
Brady KT
DOI：
10.1097/phh.0000000000000514
发表时间：
2017-09-01
影响因子：
3.3
作者：
Jiang, Yongwen;McDonald, James V.;Alexander-Scott, Nicole
通讯作者：
Alexander-Scott, Nicole
在南部农村州实施由急诊部门启动的丁丙诺啡治疗阿片类药物使用障碍。
影响因子：
3.9
作者：
Bogan C;Jennings L;Haynes L;Barth K;Moreland A;Oros M;Goldsby S;Lane S;Funcell C;Brady K
通讯作者：
Brady K
影响因子：
17.7
作者：
Lin, Lewei (Allison);Zhang, M. S. Lan;Kim, Hyungjin Myra;Frost, Madeline C.
通讯作者：
Frost, Madeline C.
影响因子：
3.9
作者：
Lin LA;Fortney JC;Bohnert ASB;Coughlin LN;Zhang L;Piette JD
通讯作者：
Piette JD