Sean M Murphy1, Daniel Polsky2, Joshua D Lee3, Peter D Friedmann4, Timothy W Kinlock5,6, Edward V Nunes7, Richard J Bonnie8, Michael Gordon5, Donna T Chen9, Tamara Y Boney10, Charles P O'Brien11. 1. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. 2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. 3. Departments of Population Health, Medicine, Division of General Internal Medicine and Clinical Innovation, New York University, New York, NY, USA. 4. Baystate Health, University of Massachusetts Medical School-Baystate, Springfield, MA, USA. 5. Friends Research Institute, Baltimore, MD, USA. 6. School of Criminal Justice, University of Baltimore, Baltimore, MD, USA. 7. New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York, USA. 8. School of Law, University of Virginia, Charlottesville, VA, USA. 9. Center for Biomedical Ethics and Humanities, University of Virginia Health System, Charlottesville, VA, USA. 10. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA. 11. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND AND AIMS: Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol® ) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. DESIGN: Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. SETTING: Five study sites in the US Northeast corridor. PARTICIPANTS: A total of 308 participants were randomized to XR-NTX (n = 153) or TAU (n = 155). MEASUREMENTS: Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. FINDINGS: The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. CONCLUSIONS: While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection.
RCT Entities:
BACKGROUND AND AIMS: Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol® ) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. DESIGN: Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. SETTING: Five study sites in the US Northeast corridor. PARTICIPANTS: A total of 308 participants were randomized to XR-NTX (n = 153) or TAU (n = 155). MEASUREMENTS: Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. FINDINGS: The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. CONCLUSIONS: While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection.
Authors: Stephen Magura; Joshua D Lee; Jason Hershberger; Herman Joseph; Lisa Marsch; Carol Shropshire; Andrew Rosenblum Journal: Drug Alcohol Depend Date: 2008-10-18 Impact factor: 4.492
Authors: Timothy W Kinlock; Michael S Gordon; Robert P Schwartz; Kevin O'Grady; Terrence T Fitzgerald; Monique Wilson Journal: Drug Alcohol Depend Date: 2007-07-12 Impact factor: 4.492
Authors: Sean M Murphy; Kathryn E McCollister; Jared A Leff; Xuan Yang; Philip J Jeng; Joshua D Lee; Edward V Nunes; Patricia Novo; John Rotrosen; Bruce R Schackman Journal: Ann Intern Med Date: 2018-12-18 Impact factor: 25.391
Authors: Ali Jalali; Philip J Jeng; Daniel Polsky; Sabrina Poole; Yi-Chien Ku; George E Woody; Sean M Murphy Journal: J Subst Abuse Treat Date: 2022-07-02
Authors: Laura C Fanucchi; Sean M Murphy; Hilary Surratt; Shashi N Kapadia; Sharon L Walsh; James A Grubbs; Alice C Thornton; Paul Nuzzo; Michelle R Lofwall Journal: Ther Adv Infect Dis Date: 2022-07-11
Authors: Alexander J Cowell; Gary A Zarkin; Brendan J Wedehase; Jennifer Lerch; Scott T Walters; Faye S Taxman Journal: J Subst Abuse Treat Date: 2018-01-31
Authors: Erica N Onuoha; Jared A Leff; Bruce R Schackman; Kathryn E McCollister; Daniel Polsky; Sean M Murphy Journal: Value Health Date: 2021-05-08 Impact factor: 5.101
Authors: Joshua A Barocas; Jake R Morgan; David A Fiellin; Bruce R Schackman; Golnaz Eftekhari Yazdi; Michael D Stein; Kenneth A Freedberg; Benjamin P Linas Journal: Int J Drug Policy Date: 2019-05-10