Impact of improved access to medications for opioid use disorder in residential treatment
Mathieu Castry, Hana Zwick, Joshua Barocas, Zachary F. Meisel, Alexander Y. Walley, Benjamin P. LinasAbstract
Background and aim
Health officials in the United States (USA) are seeking strategies to mitigate overdose mortality. Medications for opioid use disorder (MOUD) are effective but underused in residential treatment centers. We used a simulation model to investigate population‐level health and health economic impacts of requiring residential treatment centers to offer MOUD to patients with opioid use disorder (OUD).
Design, setting and participants
We used a cohort state‐transition model in Massachusetts, USA, simulating 4 strategies: (1) status quo – a small fraction of residential centers offers MOUD; (2) ‘Improved MOUD’ – all residential centers routinely offer MOUD to admitted patients; (3) ‘Improved MOUD with linkage’ – adding linkage to outpatient MOUD for those discharged on MOUD; and (4) ‘Improved MOUD with extended linkage’ – adding linkage for all patients being discharged. We used two complementary simulation approaches: a closed cohort estimating per‐person outcomes for residential treatment patients and an open cohort estimating state‐level impacts across the Massachusetts OUD population.
Measurements
Outcomes included person‐time on MOUD, overdose fatalities, costs (2024 US dollars), cost‐effectiveness and budgetary impact.
Results
In the closed cohort, compared with the status quo, the ‘Improved MOUD’ strategy increased person‐time in MOUD by 36% and prevented 5 [95% uncertainty interval (UI) = 1–6] overdose deaths per 10 000 individuals at one year. Over a lifetime horizon, this strategy extended life expectancy by 0.0041 life‐years (LY) and discounted quality‐adjusted life expectancy by 0.0034 quality‐adjusted life‐years (QALY) at an incremental lifetime cost per person of $309. ‘Improved MOUD with extended linkage’ was the preferred strategy, providing more LY (0.0096) and QALY (0.0080) at lower incremental cost ($198). The incremental cost‐effectiveness ratio compared with the status quo was $40 195/QALY gained. At the state level, this strategy prevented 2.64 (95% UI = 0.49–4.76) overdose deaths per 10 000 individuals over 10 years (a 0.40% reduction). The 5‐year budgetary impact to the Massachusetts health care system of providing MOUD in residential treatment was $9.65 million. Findings were robust in sensitivity analyses; however, there is some risk of unintended consequences should facilities choose to close rather than offer MOUD. In a scenario in which 21% of sites closed (reflecting centers that discourage MOUD) outcomes were worse than under the status quo.
Summary
Residential treatment programs for opioid use disorder appear to be an effective and cost‐effective venue for expanding the use of medications for opioid use disorder, with the greatest value achieved when care navigation links patients to community‐based treatment upon discharge.