Table 1.
Study overview: cost offset and utilization studies
| Study | Country | Population | Intervention | Comparator | Study Design | Perspective and time horizon | Model and Outcomes | Findings | Ratings |
|---|---|---|---|---|---|---|---|---|---|
| Methadone compared to no pharmacologic treatment | |||||||||
| Krebs et al., 201724 | USA | criminal justice-involved adults admitted to publicly-funded OUD treatment in California from 2006 to 2010 | methadone | detoxification | observational (cohort analysis) | societal at 6 months | daily costs of crime, net criminal justice costs (2014 USD) | Daily costs of crime were $126 lower for methadone (95% CI: $116, $136) and $144 lower for detoxification (95% CI = $135, $154). Savings were estimated at $17,550 ($16,840, $18,383) at 6 months for adults enrolled in methadone compared to detoxification. | 10 Good |
| Buprenorphine treatment modalities | |||||||||
| Hsu et al. 201925 | USA | adults aged 18 to 64 enrolled in a Medicaid Managed Care plan in Maryland from 2008 to 2012 | integrated primary care and BUP onsite | BUP offsite | observational (cohort analysis) | third party payer at 6 and 12 months | BUP retention, hospital and ED utilization, healthcare costs (unknown USD) | Patients receiving integrated care compared to BUP offsite remained on treatment (79% vs 61%; p<0.001), experienced no significant difference in hospital and ED utilization, and had significantly lower health care costs ($4554; p<0.001). | 7 Average |
| Multiple Medications: combinations of two or more of the following buprenorphine, methadone, injectable hydromorphone, injectable diacetylmorphine, injectable naltrexone | |||||||||
| Shah et al. 201821 | USA | opioid dependent adults with 2 claims for XR-NTX, BUP, or methadone, or 3 claims for non-pharmacologic treatment between 2011 and 2014 | XR-NTX | methadone, BUP, or non-pharmacologic treatment | observational (cohort analysis) | third party payer baseline (1 year prior to index date) and follow-up (1-year post index date) |
healthcare costs including inpatient, outpatient, emergency department, and pharmacy cost (unknown USD) | XR-NTX patients experienced no change in healthcare costs. Healthcare costs increased for BUP by 43%, methadone by 48%, and non-pharmacologic cohort by 39%. | 7.5 Average |
| Mohlman et al. 201626 | USA | adults aged 18 to 64 enrolled in Vermont Medicaid receiving OUD treatment from 2008 to 2013 | methadone or BUP | non-pharmacologic treatment | observational (serial cross-sectional design) | Vermont Medicaid at 1 year | total healthcare expenditures including OUD treatment and other healthcare (unknown USD) | Beneficiaries receiving methadone or BUP had significantly lower non-OUD treatment expenditures than non-pharmacologic treatment (−2 409; p<0.01); when OUD treatment was included, total expenditures were not significantly different (−$412; p = 0.07) | 7 Average |
XR-NTX = injectable naltrexone; BUP = buprenorphine; OUD = opioid use disorder; USD = United States Dollars; CI = confidence interval; ED = emergency department
Score rubric: poor (1–3 points); average (4–7 points); good (8–10 points).