To What Extent Does the Published Economic Analyses of Treatments for Opioid Use Disorder Capture its Chronic, Relapsing Nature and its Impact on Society?

Abstract

Objectives: Opioid use disorder (OUD) is a global problem with enormous economic, personal and public health consequences. Current estimates suggest that there are approximately 32 million illicit opioid users globally, the majority of whom misuse diamorphine (heroin) and non-prescription opioid drugs. We conducted a systematic literature review to identify evidence of the economic impact of OUD treatments. The aim was to assess to what extent the current evidence captures the chronic, relapsing nature of opioid dependence and its impact on society. Methods: We searched global electronic databases, key international health technology assessment websites, conference proceedings and reference lists from 1995-2015. Comparisons of costs and/or cost-effectiveness between two or more pharmacological maintenance interventions for OUD were included. Studies were not excluded by geographical region or language. Data quality was appraised using published checklists. Results: From 765 records, 39 studies met the inclusion criteria, including cost-effectiveness, cost-utility, cost-benefit and cost-minimisation analyses. Of these, only 10 considered a time horizon beyond 10 years, and only one considered retreatment for patients after relapse, despite the chronic nature of OUD. Twenty studies investigated a societal perspective: specifically, incarceration (n= 12), cost of crime to society and the victim (n= 14), diversion (n= 1), and productivity and workforce (n= 5). The majority of economic studies of OUD published after 2005 captured societal costs. Conclusions: This review identified an increasing interest towards understanding the societal impact of OUD treatments. However, the evidence to assess the long-term effects of the interventions is scarce. Only a few studies captured the long-term effect of treatment, and only one study was found to capture the relapsing nature of the disease. Further studies to capture long-term social factors are needed to quantify the full economic impact of OUD treatments.