Cost Effectiveness of Interventions to Reduce Morbidity from Opioid Dependency

项目背景：在过去的十年中，阿片类药物使用和注射药物使用，特别是海洛因注射， 在大多数美国人口群体中，阿片类药物使用相关的死亡率和发病率都有所增加， 公共卫生危机对退伍军人和非退伍军人。阿片类药物使用的死亡率很高，包括 艾滋病毒和丙型肝炎病毒的感染，通过共同注射中的血液转移有效传播 设备.预防阿片类药物使用障碍发病的干预措施包括阿片类药物激动剂治疗， 社会心理干预、艾滋病毒暴露前预防、清洁针头计划和加强艾滋病毒检测。 血液传播疾病，但这些干预措施在VA的成本效益尚未确定。于过往 工作，我们已经评估了干预措施的成本效益，以防止艾滋病毒的人谁注射毒品， 非退伍军人群体，并发现一些是非常昂贵的。 项目目标：这项研究将评估健康结果，成本，成本效益和预算影响， 采取干预措施，减少与类阿片使用障碍有关的发病率和死亡率。该分析将 评估单独使用或结合使用的干预措施对人口的成本效益 退伍军人。 项目方法：为了实现我们的目标，我们将开发评估健康的成本效益模型 干预措施的结果、成本、成本效益和预算影响， 阿片类药物使用障碍我们将扩展我们以前开发的模型，以反映成本， 退伍军人的特点。我们的分析将包括阿片类激动剂治疗，心理社会 干预措施，艾滋病毒暴露前预防，纳洛酮的使用，艾滋病毒和HCV的强化筛查，以及其他 阿片类药物使用障碍治疗。为了对干预措施的有效性和危害进行参数估计， 我们将系统地回顾干预研究，评估研究设计、研究质量、一致性， 适用于退伍军人群体。我们还将评估是否合并症和接受社会 服务影响阿片类药物使用障碍治疗的有效性。为了估算干预措施的成本，我们将 对VA尚未提供的干预措施使用基于文献的估计，并在可用时使用VA成本 而且合适 我们的分析将估计成本效益和预算影响。成本效益取决于 与次佳替代干预措施相比，干预措施的增量效益除以 增量成本。单一的干预措施不太可能提供与联合干预措施相同程度的益处。 干预措施。然而，需要仔细分析多种干预措施的成本效益如何变化 因为干预可能是协同的或重复的。我们的分析将解释这些 相互依存我们的分析将估计避免的死亡、治疗的不良事件、生命年 获得的质量调整生命年、避免的HIV或HCV病例（如适用）、成本，以及 增量成本效益。成本效益提供了对价值和效率的洞察。但即使 具有成本效益的方案可能需要大量的总投资。因此，我们也将估计 单个项目或项目组合中项目的预算影响。预算影响反映的是 在不同覆盖面或扩大范围的方案实施所需的资源。这项研究将提供一个 了解哪些干预措施或干预措施的组合最有可能改善儿童的健康， 退伍军人与阿片类药物使用障碍，沿着的效率和项目的总成本的估计。

Project Background: Over the past decade, opioid use and injection drug use, particularly heroin injection, have increased across most US demographic groups, making opioid-use-related mortality and morbidity a public health crisis both for Veterans and non-Veterans. Morbidity from opioid use is broad, including acquisition of HIV and HCV, which spread efficiently through the transfer of blood in shared injecting equipment. Interventions to prevent morbidity from opioid use disorder include opioid agonist therapy, psychosocial interventions, HIV pre-exposure prophylaxis, clean needle programs, and enhanced testing for blood-borne diseases, but the cost effectiveness of these interventions in VA has not been determined. In prior work, we have evaluated the cost effectiveness of interventions to prevent HIV for people who inject drugs in non-Veteran populations and found some to be very expensive. Project Objectives: This study will assess health outcomes, costs, cost effectiveness, and budget impact of interventions to reduce the morbidity and mortality associated with opioid use disorder. The analysis will assess the cost effectiveness of interventions used individually or in combination when applied to populations of Veterans. Project Methods: To accomplish our objectives we will develop cost effectiveness models that assess health outcomes, cost, cost effectiveness, and budget impact of interventions to reduce morbidity and mortality from opioid use disorders. We will extend models that we have developed previously to reflect the costs and population characteristics of Veterans. Our analyses will include opioid agonist therapy, psychosocial interventions, HIV pre-exposure prophylaxis, use of naloxone, intensive screening for HIV and HCV, and other opioid use disorder treatments. To develop parameter estimates of effectiveness and harms of interventions, we will systematically review studies of interventions and assess study design, study quality, consistency, and applicability to Veteran populations. We will also assess whether comorbid conditions and receipt of social services affects the effectiveness of opioid use disorder treatment. To estimate costs of interventions we will use both literature-based estimates for interventions that VA has not provided and VA costs where available and appropriate. Our analyses will estimate both cost effectiveness and budget impact. Cost effectiveness is determined by the incremental benefit of an intervention compared to the next best alternative intervention divided by the incremental costs. Single interventions are unlikely to provide the same degree of benefit as combined interventions. However, how cost effectiveness varies for multiple interventions requires careful analyses because interventions may be synergistic or duplicative. Our analyses will account for these interdependencies. Our analyses will estimate deaths averted, adverse events from treatment, life years gained, quality-adjusted life years gained, cases of HIV or HCV averted (where appropriate), costs, and incremental cost effectiveness. Cost effectiveness provides insight into value and efficiency. However, even programs that are cost effective may require large total investments. Therefore, we will also estimate the budget impact of programs singly or in a portfolio. Budget impact captures the total expenditures that are required for implementation of programs at various levels of coverage or scale up. The study will provide an understanding of which interventions or combinations of interventions are likely to most improve the health of Veterans with opioid use disorder, along with estimates of the efficiency and total costs of the programs.