Expanding FDA's Opioids Systems Model to Enable Economic Evaluations and Outcome Analyses of National Opioid Policies

项目总结/摘要 该项目的目标是扩展FDA目前的阿片类药物系统模型， 成果和成本效益分析。阿片类药物滥用和紊乱、过量和 1990年代以来的死亡是一场对社会产生深远影响的公共卫生危机。OUD上升， 从2015年到2019年，过量死亡与美国每年预期寿命的下降有关。 2017年，这是自1993年以来的首次多年下降。虽然死亡率显然是一个重要的结果， 考虑到在分析政策的影响时，决策者和利益相关者还关心如何 政策影响到对社会重要的其他结果。该项目将扩大FDA的阿片类药物系统模型， 包括其他成果，并能够对政策和干预措施进行成本效益分析， 减少阿片类药物滥用，OUD和过量。我们将作为一个团队开发拟议的模型扩展， 在卫生经济学和成果研究、模拟建模方面拥有丰富经验的专家， 物质使用障碍健康科学和政策。我们将首先扩展模型，以包括其他影响 阿片类药物滥用，OUD和过量对生活质量和生产力损失的影响，以及犯罪的社会成本 司法和保健系统（目标1）。然后，我们将估计成本，并审查预期和 与旨在减少滥用、OUD和 致死性和非致死性过量（目的2）。最后，我们将研究在这些框架下的潜在政策战略 有效性和成本效益分析。在这些分析中，我们将比较有效性和 旨在减少阿片类药物滥用的干预措施和政策组合的成本效益 过量用药（目标3），如实施处方控制，扩大MOUD的使用范围， 纳洛酮的分布这些目标最终将实现：1）一个能够代表新的 2）决策者对各种政策选择组合如何 将影响这些多层面的结果;和3）辨别哪些政策选择代表 最有效地分配资源，同时最大限度地减少意外后果。该模型 扩展和伴随的分析将使FDA的政策工具能够拓宽FDA的透镜， 和其他政府机构考虑旨在减少阿片类药物滥用的政策解决方案的影响， 还有吸毒过量

PROJECT SUMMARY/ABSTRACT The goal of this project is to expand FDA's current opioids systems model to enable multidimensional outcomes and cost-effectiveness analyses. Steep increases in opioid misuse and disorder, overdoses, and deaths since the 1990s represent a public health crisis with far-reaching impacts on society. Rising OUD and overdose deaths are linked with the decline in life expectancy in the United States each year from 2015 to 2017, which was the first multi-year decrease since 1993. While mortality is clearly an important outcome to consider when analyzing the effects of a policy, decision makers and stakeholders also care about how policies affect other outcomes that matter to society. This project will expand FDA's opioids systems model to include additional outcomes and enable cost-effectiveness analyses of policies and interventions meant to reduce opioid misuse, OUD, and overdose. We will develop the proposed model expansion as a team of experts with extensive experience in health economics and outcomes research, simulation modeling, and substance use disorder health science and policy. We will first expand the model to include additional impacts of opioid misuse, OUD, and overdose on quality of life and productivity loss, and societal costs to criminal justice and health care systems (Aim 1). We will then estimate costs and examine both intended and unintended outcomes associated with interventions and policy changes meant to reduce misuse, OUD, and fatal and non-fatal overdose (Aim 2). Finally, we will examine potential policy strategies under the frameworks of effectiveness and cost-effectiveness analyses. In these analyses, we will compare the effectiveness and cost-effectiveness of combinations of interventions and policies meant to reduce opioid misuse, OUD, and overdose (Aim 3), such as implementation of prescription controls, expanded access to MOUD, and increased distribution of naloxone. These aims will ultimately deliver: 1) an expanded model that is able to represent new outcomes as well as costs; 2) insight for policymakers regarding how various combinations of policy options will affect these multidimensional outcomes; and 3) the ability to discern which policy options represent the most efficient allocation of resources while minimizing unintended consequences. The proposed model expansion and accompanying analyses will enable FDA's policy tool to broaden the lens through which FDA and other government agencies consider the impact of policy solutions meant to reduce opioid misuse, OUD, and overdose.