Table 1. Base Case Parameter Values and Sources.
| Parameter | Mean (range) | Source |
|---|---|---|
| Male, % | 51.1 | Substance Abuse and Mental Health Data Archive3;US Census Bureau22 |
| Female, % | 48.9 | Substance Abuse and Mental Health Data Archive3;US Census Bureau22 |
| Age, mean, y | ||
| Male | 43.7 | Substance Abuse and Mental Health Data Archive3;US Census Bureau22 |
| Female | 45.3 | Substance Abuse and Mental Health Data Archive3;US Census Bureau22 |
| Initial fraction with OUD who inject drugs | 0.253 (0.214-0.294) | Substance Abuse and Mental Health Data Archive23 |
| Transition | ||
| Death and overdose, annual rates per person | ||
| Background mortality | CDC life tables | Arias24 |
| Nonoverdose excess mortality due to OUD, out of treatment | ||
| Out of treatment | 0.00978 (0.00744-0.01249) | Ma et al25 |
| In treatment | 0.00318 (0.00238-0.00406) | Ma et al25 |
| Multiplier for increased all-cause mortality when inducted onto methadone | 14.0 (1.08-62.16) | Ma et al25 |
| Overdose | ||
| Out of treatment | 0.103 (0.0472-0.2206) | Kelty et al26 |
| In treatment | 0.0438 (0.0205-0.0932) | Kelty et al26 |
| Overdose survival probability, per overdosea | ||
| Death after overdose, out of treatment | ||
| Without naloxone | 0.899 (0.799-0.954) | Coffin and Sullivan15 |
| With naloxone | 0.909 (0.826-0.967) | Coffin and Sullivan15 |
| Treatment discontinuation, annual rates/person | ||
| Discontinuation | ||
| From methadone | 1.051 (0.579-1.751) | Hser et al27;Neumann et al28; Otiashvili et al29; Potter et al30 |
| From buprenorphine | 1.609 (1.002-2.420) | Hser et al27; Neumann et al28; Otiashvili et al29; Lee et al31; Ruger et al32; Tanum et al33; Potter et al30 |
| From naltrexone | 1.588 (1.095-2.172) | Lee et al31; Ruger et al32; Tanum et al33; Krupitsky et al34; Krupitsky et al35; Jarvis et al36 |
| Hazard rate ratio for treatment discontinuation | ||
| Psychotherapy | 0.986 (0.772-1.240) | Ling et al37; McLellan et al38; Schwartz et al39; Tetrault et al40; Gruber et el41; Gu et al42; Fiellin et al43; Weiss et al23 |
| Contingency management | 0.594 (0.437-0.787) | Ling et al37; Chen et al44; DeFulio et al45; Dunn et al46; Hser et al47 |
| Psychotherapy combined with contingency management | 0.549 (0.356-0.732) | Ling et al37 |
| Other transitions | ||
| Reentry into treatment (from out of treatment >1 mo) | 0.426 (0.367-0.489) | Krebs et al16 |
| Becoming abstinent and leaving treatment | 0.316 (0.296-0.337) | Krebs et al16 |
| Becoming abstinent, from out of treatment | 0.0791 (0.00401-0.1551) | Estimated |
| Relapse from abstinence <1 yb | 0.379 (0.331-0.430) | Krebs et al16 |
| Relapse from abstinence, ≥10 y | 0.019 (0.00394-0.0342) | Krebs et al16 |
| Rate of initiating IDU | 0.031 (0.020-0.043) | Carlson et al48 |
| Cost, $c | ||
| Annual background health care costs | ||
| Baseline, male aged 30 yd | 2246 | Meara et al49; Liu et al50 |
| Excess cost for OUD | ||
| Out of treatment | 7176 (6476-7911) | Baser et al4 |
| In treatmente | 5748 (2990-8659) | Baser et al51 |
| Annual criminal justice costs, patient aged 30 yf | ||
| Out of treatment | 38 960 (35 365– 42 575) | Krebs et al52 |
| Out of treatment (IDU) | 59 554 (55 612– 63 514) | Krebs et al52 |
| Receiving treatment | 8790 (7886-9700) | Krebs et al52 |
| Receiving treatment (IDU) | 19 665 (18 004-21 334) | Krebs et al52 |
| Abstinent | 5105 (4636-5577) | Krebs et al52 |
| Abstinent (IDU) | 7801 (7282-8322) | Krebs et al52 |
| Annual treatment costs | ||
| Methadone | 6979 (6298-7694) | US Department of Defense21 |
| Buprenorphine | 6370 (5749-7023) | US Department of Defense21 |
| Extended-release naltrexone | 15 032 (13 566-16 572) | US Department of Defense21 |
| Psychotherapy | 4296 (3877-4736) | US Department of Defense21 |
| Contingency management | 3385 (3055-3732) | VA datag |
| Naloxone cost, per initial provision or refill | 71 (64-78) | VA data |
| Health care cost per overdose | ||
| Without naloxone | 2580 (1117-5108) | Coffin et al15 |
| With naloxone | 2063 (884-4116) | Coffin et al15 |
| Quality-of-life multipliers for health states | ||
| Out of treatment | ||
| Month 1 | 0.670 (0.660-0.680) | Krebs et al16; Nosyk et al53 |
| Out of treatment (IDU) | ||
| Month 1 | 0.660 (0.640-0.680) | Krebs et al16; Nosyk et al53 |
| Out of treatment | ||
| Month >1 | 0.670 (0.660-0.680) | Krebs et al16; Nosyk et al53 |
| Out of treatment (IDU) | ||
| Month >1 | 0.660 (0.640-0.680) | Krebs et al16; Nosyk et al53 |
| Induction | ||
| Into treatment | 0.725 (0.700-0.750) | Krebs et al16; Nosyk et al53 |
| Into treatment (IDU) | 0.710 (0.700-0.720) | Krebs et al16; Nosyk et al53 |
| Receiving treatment | 0.725 (0.700-0.750) | Krebs et al16; Nosyk et al53 |
| Receiving treatment (IDU) | 0.710 (0.700-0.720) | Krebs et al16; Nosyk et al53 |
| Abstinence | ||
| First yearh | 0.725 (0.700-0.750) | Krebs et al16; Fryback et al54 |
| Abstinence (IDU) | ||
| First year | 0.710 (0.700-0.720) | Krebs et al16; Fryback et al54 |
| Abstinence | ||
| Year ≥10 | 0.984 (0.970-0.996) | Calculated |
| Abstinence (IDU) | ||
| Year ≥10 | 0.983 (0.969-0.996) | Calculated |
Abbreviations: CDC, US Centers for Disease Control and Prevention; IDU, injection drug use; OUD, opioid use disorder.
a
For calculations, see the eMethods and eFigure 27 in the Supplement.
b
Rates of relapse from abstinence from years 2 to 9 of abstinence were linear interpolations of the year 1 and year 10 values.
c
All costs were updated to 2019 currency using the Consumer Price Index.
d
Baseline health care costs were age- and sex-specific.
e
Estimated based on the (conservative) assumption that patients with OUD who are receiving treatment incur 20% higher health care costs on average than those not receiving treatment because of increased access to health care.
f
Criminal justice costs for other ages were calculated based on the study by Krebs et al.16
g
See the eMethods and eTable 9 in the Supplement.
h
Utility values for years 2 through 9 were linear interpolations of the year 1 and year ≥10 utility values.