Determining the Most Cost-Effective Option to Treat Opioid Use Disorder

A team of researchers from The Institute for Clinical and Economic Review (ICER) recently examined the cost-effectiveness and value for use of the extended-release partial opioid agonist, CAM2038, among patients with opioid use disorder (OUD). Varun Kumar, MPH, MSc, associate director of health economics at ICER recently discussed the findings during a podium session at the ISPOR annual meeting. 

According to Mr Kumar, there are 2.1 million OUD patients. He explained that this high number of patients with OUD has led to $504 billion or $2.8% of the gross domestic product, 116 opioid overdose deaths per day, and a decreasing overall life expectancy. 

In an effort to better understand the costs related to another OUD treatment, Mr Kumar and his associates used a decision analytic model to estimate the cost-effectiveness of CAM2038 vs sublingual buprenorphine/naloxone among patients with and seeking treatment for OUD. 

For their study, Mr Kumar told conference attendees that they included adults diagnosed with and seeking treatment for OUD. He said that the mean age of patients was 36 years, 30% were female, and the proportion using a prescription opioid vs injecting was 50:50. 

Mr Kumar said that he and his colleagues developed a de novo Markov model that compared CAM2038 and generic sublingual buprenorphine/ naloxone. The model used a US health care sector perspective over a 5-year time horizon with 4-week cycles. The model also used costs and outcomes that were discounted at 3% annually. 

According to Mr Kumar, the model comprised five health states: 

• Medications for addiction treatment (MAT) with Illicit Use of Opioids; 
• MAT with NO Illicit Use of Opioids; 
• OFF MAT with Illicit Use of Opioids; 
• OFF MAT with NO Illicit Use of Opioids; and, 
• Death. 

“Costs included drug, drug administration and monitoring, and nondrug health care costs, as applicable,” explained Mr Kumar. “In the absence of a price, using published evidence on its efficacy, we calculated the annual prices at which CAM2038 would achieve the $100,000 to $150,000 per quality-adjusted life year (QALY) CE [cost-effectiveness] thresholds.” 

According to the findings of the study, there was only a marginal QALY gain for patients treated with CAM2038 compared with generic treatment (3.26 vs 3.20). It was noted that there was a higher rate of abstinence from illicit use of opioids when using CAM2038. Further, this QALY gain was predicted due to a higher rate of discontinuation relative to generic sublingual bupreniorphine/ naloxone. 

“CAM2038’s estimated annual price to achieve CE thresholds of $100,000 to $150,000 per QALY was between $4100 and $5300,” Mr Kumar said. 

According to the study, “With only marginal clinical improvements relative to its comparator, treatment of OUD with CAM2038 would reflect long-term value for money only at annual prices no more than $2300 above that of generic sublingual buprenorphine/naloxone ($3000 per year).”

—Julie Gould