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Jalali A. Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies. Expert Rev Pharmacoecon Outcomes Res 2024; 24:599-611. [PMID: 38696161 DOI: 10.1080/14737167.2024.2350561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. AREAS COVERED In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. EXPERT OPINION Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Division of Comparative Effectiveness & Outcomes Research, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
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Adams MCB, Hurley RW, Siddons A, Topaloglu U, Wandner LD. NIH HEAL Clinical Data Elements (CDE) implementation: NIH HEAL Initiative IMPOWR network IDEA-CC. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:743-749. [PMID: 36799548 PMCID: PMC10321760 DOI: 10.1093/pm/pnad018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE The National Institutes of Health (NIH) HEAL Initiative is making data findable, accessible, interoperable, and reusable (FAIR) to maximize the value of the unprecedented federal investment in pain and opioid-use disorder research. This involves standardizing the use of common data elements (CDE) for clinical research. METHODS This work describes the process of the selection, processing, harmonization, and design constraints of CDE across a pain and opioid use disorder clinical trials network (NIH HEAL IMPOWR). RESULTS The network alignment allowed for incorporation of newer data standards across the clinical trials. Specific advances included geographic coding (RUCA), deidentified patient identifiers (GUID), shareable clinical survey libraries (REDCap), and concept mapping to standardized concepts (UMLS). CONCLUSIONS While complex, harmonization across a network of chronic pain and opioid use disorder clinical trials with separate interventions can be optimized through use of CDEs and data standardization processes. This standardization process will support the robust secondary data analyses. Scaling this process could standardize CDE results across interventions or disease state which could help inform insurance companies or government organizations about coverage determinations. The development of the HEAL CDE program supports connecting isolated studies and solutions to each other, but the practical aspects may be challenging for some studies to implement. Leveraging tools and technology to simplify process and create ready to use resources may support wider adoption of consistent data standards.
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Affiliation(s)
- Meredith C B Adams
- Departments of Anesthesiology, Biomedical Informatics, and Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Robert W Hurley
- Departments of Anesthesiology, Translational Neuroscience, and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States
| | - Andrew Siddons
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Umit Topaloglu
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, United States
| | - Laura D Wandner
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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Ryan DA, Montoya ID, Koutoujian PJ, Siddiqi K, Hayes E, Jeng PJ, Cadet T, McCollister KE, Murphy SM. Budget impact tool for the incorporation of medications for opioid use disorder into jail/prison facilities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208943. [PMID: 36880906 PMCID: PMC10084043 DOI: 10.1016/j.josat.2022.208943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/02/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Given the personal and public consequences of untreated/undertreated OUD among persons involved in the justice system, an increasing number of jails and prisons are incorporating medication for opioid use disorder (MOUD) into their system. Estimating the costs of implementing and sustaining a particular MOUD program is vital to detention facilities, which typically face modest, fixed health care budgets. We developed a customizable budget impact tool to estimate the implementation and sustainment costs of numerous MOUD delivery models for detention facilities. METHODS The aim is to describe the tool and present an application of a hypothetical MOUD model. The tool is populated with resources required to implement and sustain various MOUD models in detention facilities. We identified resources via micro-costing techniques alongside randomized clinical trials. The resource-costing method is used to assign values to resources. Resources/costs are categorized as (a) fixed, (b) time-dependent, and (c) variable. Implementation costs include (a), (b), and (c) over a specified timeframe. Sustainment costs include (b) and (c). The MOUD model example entails offering all three FDA-approved medications, with methadone and buprenorphine provided by vendors, and naltrexone by the jail/prison facility. RESULTS Fixed resources/costs are incurred only once, including accreditation fees and trainings. Time-dependent resources/costs are recurring, but fixed over a given time-period; e.g., medication delivery and staff meetings. Variable resources/costs are those that are a direct function of the number of persons treated, such as the medication provided to each patient. Using nationally representative prices, we estimated fixed/sustainment costs to be $2919/patient, over 1 year. This article estimates annual sustainment costs to be $2885/patient. CONCLUSION The tool will serve as a valuable asset to jail/prison leadership, policymakers, and other stakeholders interested in identifying/estimating the resources and costs associated with alternative MOUD delivery models, from the planning stages through sustainment.
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Affiliation(s)
- Danielle A Ryan
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America.
| | - Iván D Montoya
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Peter J Koutoujian
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Kashif Siddiqi
- Middlesex House of Corrections and Jail, 269 Treble Cove Rd., North Billerica, MA 01862, United States of America
| | - Edmond Hayes
- Franklin County Jail, 160 Elm St., Greenfield, MA 01301, United States of America
| | - Philip J Jeng
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Techna Cadet
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
| | - Kathryn E McCollister
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 N.W. 14(th) Street, Suite 1024, Miami, FL 33136, United States of America
| | - Sean M Murphy
- Weill Cornell Medical College, Department of Population Health Sciences, 425 East 61(st) Street, Suite 301, New York, NY 10065, United States of America
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Morgan JR, Walley AY, Murphy SM, Chatterjee A, Hadland SE, Barocas J, Linas BP, Assoumou SA. Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort. Drug Alcohol Depend 2021; 225:108764. [PMID: 34051547 PMCID: PMC8488795 DOI: 10.1016/j.drugalcdep.2021.108764] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS While the United States is in the midst of an overdose epidemic, effective treatments are underutilized and commonly discontinued. Innovations in medication delivery, including an extended-release formulations, have the potential to improve treatment access and reduce discontinuation. We sought to assess extended-release buprenorphine discontinuation among individuals with opioid use disorder (OUD) in a real-world, nationally representative cohort. SETTING United States PARTICIPANTS: Commercially insured individuals initiating one of four FDA-approved medications for opioid use disorder (MOUD) in 2018: extended-release buprenorphine, extended-release naltrexone, mucosal buprenorphine (mono- or co-formulated with naloxone), or methadone. MEASUREMENTS Our primary outcome was medication discontinuation, defined as a gap of more than 14 days between the end of one prescription or administration and the subsequent dose. FINDINGS We identified 14,358 individuals initiating MOUD in 2018, including 204 (1%) extended-release buprenorphine, 1,173 (8%) extended-release naltrexone, 12,171 (85%) mucosal buprenorphine, and 810 (6%) methadone initiations. Three months after initiation, 50% (95% confidence interval [CI] 40%-60%) of extended-release buprenorphine, 64% (95% CI 61%-69%) of extended-release naltrexone, 34% (95% CI 33%-35%) of mucosal buprenorphine, and 58% (95% CI 54%-62%) of methadone initiators had discontinued treatment. CONCLUSIONS Across all treatment groups, medication discontinuation was high, and in this sample of early adopters with limited follow-up time, we found no evidence that extended-release buprenorphine offered a retention advantage compared to other MOUD in real-world settings. Retention continues to represent a major obstacle to treatment effectiveness, and interventions are needed to address this challenge even as new MOUD formulations become available.
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Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Avik Chatterjee
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Scott E Hadland
- Grayken Center for Addiction, Division of General Pediatrics, Department of Medicine, Boston Medical Center, Boston, MA, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Joshua Barocas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Benjamin P Linas
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sabrina A Assoumou
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
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Ducharme LJ, Wiley TRA, Mulford CF, Su ZI, Zur JB. Engaging the justice system to address the opioid crisis: The Justice Community Opioid Innovation Network (JCOIN). J Subst Abuse Treat 2021; 128:108307. [PMID: 33531212 DOI: 10.1016/j.jsat.2021.108307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
Many individuals with opioid use disorder come into contact with the justice system each year, making the nexus between the criminal justice system and the health care system a critical juncture for responding to the opioid crisis and simultaneously promoting public health and public safety. Collaborations across these sectors are essential to providing effective screening, treatment, and discharge planning; connecting individuals to services following release; promoting long-term recovery while reducing recidivism; and ultimately bringing the opioid crisis under control. In 2019, with the support of the NIH Helping to End Addiction Long-term (HEAL) Initiative, the National Institute on Drug Abuse launched the Justice Community Opioid Innovation Network (JCOIN). JCOIN is a >$150M multisite cooperative designed to facilitate transdisciplinary collaborations that can create actionable, translatable insights for the justice system and community-based organizations to address the opioid epidemic in justice-involved populations. JCOIN brings together 11 Research Hubs, a coordination and translation center (CTC), and a methodology and advanced analytics resource center (MAARC), with the goal of generating evidence that is greater than the sum of the parts. Collectively, the network will field at least 12 large-scale multisite clinical trials, which are described in this special issue. This article provides a brief overview of the scientific underpinnings for these trials; describes the broad themes connecting them; and discusses the intersections of the JCOIN initiative with the COVID-19 pandemic.
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Affiliation(s)
- Lori J Ducharme
- National Institute on Drug Abuse, 301 North Stonestreet Ave., Rockville, MD 20850, USA.
| | - Tisha R A Wiley
- National Institute on Drug Abuse, 301 North Stonestreet Ave., Rockville, MD 20850, USA
| | - Carrie F Mulford
- National Institute on Drug Abuse, 301 North Stonestreet Ave., Rockville, MD 20850, USA
| | - Zu-In Su
- National Institute on Drug Abuse, 301 North Stonestreet Ave., Rockville, MD 20850, USA
| | - Julia B Zur
- National Institute on Drug Abuse, 301 North Stonestreet Ave., Rockville, MD 20850, USA
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