TABLE 3.
Model estimated costs and outcomes of low-threshold buprenorphine treatment out of syringe service programs (SSPs) in Massachusetts, 2020–30
| Scenario | Total number of fatal opioid overdoses, 2020–30 (N) | Averted fatal overdoses compared to status quo,a % | Additional treatment initiations compared to status quo, % | Cost per person, 2019 US$ Health-care sector perspective | Cost per person, 2019 US$ Limited societal perspective | Total QALY per person | Incremental cost per person | Incremental QALY per person |
|---|---|---|---|---|---|---|---|---|
| Status quo | 23 051 | NA | NA | $250 582 | $399 002 | 9.377 | NA | NA |
| Main analyses (varying annual probability of uptake) | ||||||||
| 1% | 22 876 | 0.8% | 0.3% | $250 554 | $398 867 | 9.385 | $(135) | 0.01 |
| 5% | 22 171 | 3.8% | 1.6% | $250 441 | $398 336 | 9.415 | $(666) | 0.04 |
| 15% | 20 587 | 10.7% | 4.4% | $250 174 | $397 101 | 9.483 | $(1901) | 0.11 |
| 30% (base intervention scenario) | 18 254 | 20.8% | 8.6% | $249 813 | $395 390 | 9.580 | $(3612) | 0.20 |
| 45% | 16 832 | 27.0% | 11.5% | $249 429 | $393 867 | 9.655 | $(5135) | 0.28 |
| 60% | 16 118 | 30.1% | 13.5% | $249 053 | $392 538 | 9.712 | $(6464) | 0.33 |
| Sensitivity analyses | ||||||||
| Assume 40% (rather than 80%) of SSP clients actively inject | 19 757 | 14.3% | 8.5% | $249 487 | $395 344 | 9.541 | $(3658) | 0.16 |
| 50% discontinuation (rather than 10%) upon initiating low-threshold treatment | 18 208 | 21.0% | 8.6% | $249 785 | $395 356 | 9.581 | $(3646) | 0.20 |
| 90% relapse (rather than 83%) upon leaving low-threshold treatment | 18 411 | 20.1% | 9.1% | $249 898 | $395 382 | 9.567 | $(3620) | 0.19 |
| SSP treatment costs doubled ($92.06 versus $46.03 weekly, 30% annual uptake) | 18 254 | 20.8% | 8.6% | $251 580 | $397 156 | 9.580 | $(1846) | 0.20 |
| SSP clients connected to community-based buprenorphine rather than on-site treatment (30% annual uptake) | 20 308 | 11.9% | 17.4% | $250 381 | $397 285 | 9.487 | $(1717) | 0.11 |
| Weekly probability of discontinuing treatment (base: 1.3% for low-threshold and 3% for standard of care) | ||||||||
| 0.65% for low-threshold | 17 761 | 22.9% | 5.5% | $249 758 | $394 491 | 9.608 | $(4511) | 0.23 |
| 16 088 | 19.5% | 8.9% | $249 093 | $384 988 | 9.886 | $6806 | 0.17 | |
| 1.3% (standard of care and low-threshold equivalent)a | ||||||||
| 3% (standard of care and low-threshold equivalent) | 20 007 | 13.2% | 19.8% | $249 866 | $397 827 | 9.500 | $(1175) | 0.12 |
| 5.6% (low-threshold worse than standard of care) | 20 376 | 11.6% | 22.3% | $249 858 | $398 231 | 9.486 | $(771) | 0.11 |
| 2-year time horizona | 3338 | 16.4% | 12.8% | NA | NA | NA | NA | NA |
| 5-year time horizona | 8534 | 19.5% | 9.4% | NA | NA | NA | NA | NA |
Status quo comparisons made to the end of 10-year simulation period, except for the 2- and 5-year time horizon and improved retention for community-based buprenorphine (1.3% probability of discontinuation for both) sensitivities. Values for the 2-year time horizon for the status quo were as follows: 3993 fatal overdoses and 266 499 treatment initiations. Values for the 5-year time horizon for the status quo were as follows: 10603 fatal overdoses and 701 789 treatment initiations. Values for the 1.3% probability of discontinuing treatment for both community-based buprenorphine and low-threshold treatment were as follows: 19804 fatal overdoses and 1 307 903 treatment initiations. NA = not applicable; QALY = quality-adjusted life-year.