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COST-EFFECTIVENESS ANALYSIS OF EXTENDED-RELEASE MEDICATIONS FOR OPIOID USE DISORDER: Comparing Single-Drug and Multi-Drug-in-Sequence Treatment Strategies

Adams, Jeremy Tyler (2021) COST-EFFECTIVENESS ANALYSIS OF EXTENDED-RELEASE MEDICATIONS FOR OPIOID USE DISORDER: Comparing Single-Drug and Multi-Drug-in-Sequence Treatment Strategies. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Extended-release medications for opioid use disorder (ERMOUD) are newer additions to combat the opioid epidemic. While more expensive than daily-administered formulations, they offer unique advantages. These include lessening the burden and constraints of daily adherence, improving treatment retention, and potentially improving long term remission, along with eliminating the risk of drug diversion and fatal accidental poisoning in children.
Opioid use disorder (OUD) is now viewed as a chronic medical condition, requiring long-term treatment, expectant of relapses and illicit reuse, and multiple treatment strategies and trials. Therefore, it is important to evaluate the cost-effectiveness of these newer extended-release medications, along with the daily-administered formulations, in the context of this newly adopted disease paradigm.
In Chapter One, we performed a cost-effectiveness analysis of ERMOUDs in both single-drug and multi-drug-in-sequence treatment strategies, allowing for readmission and transition to another drug regimen upon discontinuation or attrition due to illicit opioid use. Prior economic models did not allow treatment reentry nor switching. We found that ERMOUD multi-drug-in-sequence combination treatment strategies prove more cost-effective than single-drug ERMOUD treatment strategies and are a cost-effective alternative to daily administration MOUD regimens.
We triplicated our model in Chapter Two to compare three different drug pricing schedules: Wholesale Acquisition Costs (WAC), Drug Manufacturer’s Net Price (DMN), and Medicaid Rebate-Adjusted Prices (MRA). We found that using MRA prices, which represents the majority of OUD patients, increases the viability and cost-effective competitiveness of ERMOUDs, while closer approximating real-world pricing conditions.
We further expanded our model in Chapter Three to include the original mainstays of MOUD, Methadone and Buprenorphine Maintenance Treatments, both singly and in multi-drug-in-sequence combinations. Thus, we were able to conduct a comprehensive cost-effectiveness analysis on essentially all available MOUD treatment strategies, allowing for readmission and drug switching. We found that, while the newer ERMOUDs are an important addition to the treatment options of OUD, and provide unique clinical advantages over the daily formulations, the single-drug BMT-only treatment strategy tested as the most cost-effective, at least until the price of both extended-release and daily formulations better align with their demonstrated benefits.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Adams, Jeremy Tylerjta23@pitt.edujta23
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDonohue, Julie Mjdonohue@pitt.edujdonohue
Committee MemberBryce, Cindy Lbryce99@pitt.edubryce99
Committee MemberChilders, Julie Wchildersjw2@upmc.educhildersjw2
Committee MemberSmith, Kenneth Jsmitkj2@upmc.edusmitkj2
Date: 10 May 2021
Date Type: Publication
Defense Date: 14 April 2021
Approval Date: 10 May 2021
Submission Date: 22 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 139
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: CEA ERMOUD OUD
Date Deposited: 10 May 2021 22:22
Last Modified: 10 May 2021 22:22
URI: http://d-scholarship.pitt.edu/id/eprint/40399

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