Table 1. Model Inputs.
| Parameter | Baseline valuea | Range evaluated | Source |
|---|---|---|---|
| Population demographics and epidemiology | |||
| Male, proportion of total people at baseline | Strategy 1: 0.58 | Strategy 1: 0.47-0.70 | Massachusetts Department of Public Health,26 2017 |
| Strategies 2 and 3: 0.61 | Strategies 2 and 3: 0.49-0.73 | ||
| Mean age, y | Strategy 1: 48.21 | Strategy 1: 38.66-58.16 | Massachusetts Department of Public Health,26 2017 |
| Strategies 2 and 3: 38.42 | Strategies 2 and 3: 28.45-48.42 | ||
| Injection drug use, proportion of total people at baseline | 0.25 | 0.20-0.30 | SAMHSA,27 2013 |
| Active drug use, proportion of total people at baseline | Strategy 1: 0.91 | Strategy 1: 0.73-1.00 | Cedarbaum et al,28 2018; Murphy et al,29 2018 |
| Strategy 2: 0.25 | Strategy 2: 0.20-0.28 | ||
| Strategy 3: 0.25 | Strategy 3: 0.20-0.30 | ||
| SMR for injection drug use | 5.07 | 4.06-6.09 | Massachusetts Department of Public Health,26 2017; US Census Bureau,30 2013 |
| SMR for noninjection drug use | 2.05 | 1.64-2.46 | Massachusetts Department of Public Health,26 2017; US Census Bureau,30 2013 |
| Transition to MOUD treatment and detoxification, monthly rate per 1000 people | |||
| Transmucosal buprenorphineand extended-release buprenorphine | 8.41 | 6.81-10.00 | Massachusetts Department of Public Health,26 2017 |
| Methadone | 2.40 | 1.92-2.92 | Massachusetts Department of Public Health,26 2017 |
| Naltrexone (injectable) | 1.08 | 0.88-1.32 | Massachusetts Department of Public Health,26 2017 |
| Detoxification | 6.80 | 5.20-8.00 | Massachusetts Department of Public Health,242020 |
| Retained on MOUD treatment, proportion at 6 mo | |||
| Transmucosal buprenorphine | 0.47 | 0.45-0.47 | IBM,31 2021 |
| Extended-release buprenorphine | 0.29 | 0.24-0.33 | IBM,31 2021 |
| Methadone | 0.66 | 0.64-0.69 | IBM,31 2021 |
| Naltrexone (injectable) | 0.32 | 0.30-0.34 | IBM,31 2021 |
| Overdose, monthly rate per 1000 people | |||
| No treatment | 6.76 | 5.40-8.00 | Massachusetts Department of Public Health,26 2017 |
| Transmucosal buprenorphineand extended-release buprenorphine | 2.72 | 2.20-3.28 | Morgan et al,32 2019 |
| Methadone | 5.08 | 4.04-6.08 | Sordo et al,4 2017 |
| Naltrexone (injectable) | 5.80 | 4.68-7.00 | Morgan et al,32 2019 |
| Fatal overdoses, proportion of total overdoses | |||
| All treatment states | 0.14 | 0.11-0.16 | Massachusetts Department of Public Health,26 2017 |
| Pharmaceutical cost | |||
| Transmucosal buprenorphine (16 mg, daily), $ | 49 | 39-58 | US Department of Veterans Affairs,11 2021 |
| Extended-release buprenorphine (100 mg or 300 mg, injection, monthly), $ | 284 | 227-341 | US Department of Veterans Affairs,11 2021 |
| Methadone (80 mg, daily), $ | 4 | 3-5 | US Department of Veterans Affairs,11 2021 |
| Naltrexone (380 mg, injection, monthly), $ | 303 | 242-363 | US Department of Veterans Affairs,11 2021 |
| Treatment utilization costb | |||
| Transmucosal buprenorphine, $ | 65 | 52-72 | Expert opinionc |
| Extended-release buprenorphine and naltrexone (injectable), $ | 24 | 19-29 | Expert opinionc |
| Methadone, $ | 123 | 99-148 | NIDA,33 2021 |
| Detoxification, $ | 2863 | 2290-3436 | McCollister et al,342018; Murphy et al,29, 2019 |
| Overdose cost, weekly | |||
| Fatal overdose cost, $ | 4557 | 3646-5469 | Coffin et al,35 2017; Jiang et al,36 2017 |
| Nonfatal overdose cost, $ | 858 | 686-1030 | Coffin et al,35 2017; Jiang et al,36 2017 |
Abbreviations: MOUD, medications for opioid use disorder; NIDA, the National Institute of Drug Abuse; SAMHSA, Substance Abuse and Mental Health Services Administration; SMR, standardized mortality ratio.
Values for all strategies are the same unless otherwise noted. Where noted, strategy 1 is no medication treatment; strategy 2 is treatment with transmucosal buprenorphine; strategy 3 is treatment with extended-release buprenorphine.
Treatment costs include any costs required in addition to the pharmaceutical cost for administration of the drug.
For parameters that were not available from the literature, addiction medicine specialists listed as coauthors for the current study were consulted for reasonable estimates. Extensive sensitivity analyses were then used to assess the robustness of all parameters in the model.