Exploratory economic evaluation of buprenorphine treatment in opioid use disorder

Hesham Farouk Elarabi; Hamad Al Ghaferi; Nael Hasan; Amanda J. Lee; Mansour Shawky; Helal Al Kathiri; Abuelgasim Elrasheed; Samya Al Maamari; Tarek A. Gawad; Doaa Radwan; Abdu Adem; John Marsden

Exploratory economic evaluation of buprenorphine treatment in opioid use disorder

Hesham Farouk Elarabi^*, Hamad Al Ghaferi, Nael Hasan, Amanda J. Lee, Mansour Shawky, Helal Al Kathiri, Abuelgasim Elrasheed, Samya Al Maamari, Tarek A. Gawad, Doaa Radwan, Abdu Adem, John Marsden

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints. Aim: To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions. Methods: The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS). Results: Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 - 635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the costbenefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively. Implications for Mental Health Policy: Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.

Original language	English
Pages (from-to)	89-95
Number of pages	7
Journal	JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS
Volume	24
Issue number	3
Publication status	Published - Sept 2021

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Cite this

@article{2e1d083793514e328d0d098a5338e27c,

title = "Exploratory economic evaluation of buprenorphine treatment in opioid use disorder",

abstract = "Background: Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints. Aim: To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions. Methods: The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS). Results: Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 - 635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the costbenefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively. Implications for Mental Health Policy: Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment. ",

author = "Elarabi, {Hesham Farouk} and {Al Ghaferi}, Hamad and Nael Hasan and Lee, {Amanda J.} and Mansour Shawky and {Al Kathiri}, Helal and Abuelgasim Elrasheed and {Al Maamari}, Samya and Gawad, {Tarek A.} and Doaa Radwan and Abdu Adem and John Marsden",

note = "Funding Information: The authors kindly acknowledge the educational support of the Scholarship Office (SCO) at the Ministry of Presidential Affairs to complete this work. The authors further thank the National Rehabilitation Centre for its support. Publisher Copyright: {\textcopyright} 2021 ICMPE.",

year = "2021",

month = sep,

language = "English",

volume = "24",

pages = "89--95",

journal = "JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS",

issn = "1091-4358",

publisher = "ICMPE",

number = "3",

}

TY - JOUR

T1 - Exploratory economic evaluation of buprenorphine treatment in opioid use disorder

AU - Elarabi, Hesham Farouk

AU - Al Ghaferi, Hamad

AU - Hasan, Nael

AU - Lee, Amanda J.

AU - Shawky, Mansour

AU - Al Kathiri, Helal

AU - Elrasheed, Abuelgasim

AU - Al Maamari, Samya

AU - Gawad, Tarek A.

AU - Radwan, Doaa

AU - Adem, Abdu

AU - Marsden, John

N1 - Funding Information: The authors kindly acknowledge the educational support of the Scholarship Office (SCO) at the Ministry of Presidential Affairs to complete this work. The authors further thank the National Rehabilitation Centre for its support. Publisher Copyright: © 2021 ICMPE.

PY - 2021/9

Y1 - 2021/9

N2 - Background: Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints. Aim: To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions. Methods: The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS). Results: Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 - 635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the costbenefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively. Implications for Mental Health Policy: Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.

AB - Background: Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints. Aim: To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions. Methods: The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a '0' to '1' scale, where '0' represents no impairment and '1' full impairment using the Work and Social Adjustment Scale (WSAS). Results: Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 - 635,725.3) and AED 538,694.4 (4,211,398.0 - 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the costbenefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively. Implications for Mental Health Policy: Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.

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M3 - Article

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AN - SCOPUS:85117434376

SN - 1091-4358

VL - 24

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EP - 95

JO - JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS

JF - JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS

IS - 3

ER -

Exploratory economic evaluation of buprenorphine treatment in opioid use disorder

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