From British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; UCLA Integrated Substance Abuse Programs and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts; and Simon Fraser University Faculty of Health Sciences, Vancouver, British Columbia, Canada.
Ann Intern Med. 2018 Jan 2;168(1):10-19. doi: 10.7326/M17-0611. Epub 2017 Nov 21.
Only 1 in 5 of the nearly 2.4 million Americans with an opioid use disorder received treatment in 2015. Fewer than half of Californians who received treatment in 2014 received opioid agonist treatment (OAT), and regulations for admission to OAT in California are more stringent than federal regulations.
To determine the cost-effectiveness of OAT for all treatment recipients compared with the observed standard of care for patients presenting with opioid use disorder to California's publicly funded treatment facilities.
Model-based cost-effectiveness analysis.
Linked population-level administrative databases capturing treatment and criminal justice records for California (2006 to 2010); published literature.
Persons initially presenting for publicly funded treatment of opioid use disorder.
Lifetime.
Societal.
Immediate access to OAT with methadone for all treatment recipients compared with the observed standard of care (54.3% initiate opioid use disorder treatment with medically managed withdrawal).
Discounted quality-adjusted life-years (QALYs) and discounted costs.
RESULTS OF BASE-CASE ANALYSIS: Immediate access to OAT for all treatment recipients costs less (by $78 257), with patients accumulating more QALYs (by 0.42) than with the observed standard of care. In a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, total lifetime savings for this cohort could be as high as $3.8 billion.
99.6% of the 2000 simulations resulted in lower costs and more QALYs.
Nonrandomized delivery of OAT or medically managed withdrawal.
The value of publicly funded treatment of opioid use disorder in California is maximized when OAT is delivered to all patients presenting for treatment, providing greater health benefits and cost savings than the observed standard of care.
National Institute on Drug Abuse.
2015 年，近 240 万阿片类药物使用障碍患者中仅有 1/5 接受了治疗。2014 年在加利福尼亚接受治疗的患者中，不到一半接受了阿片类药物激动剂治疗（OAT），而加利福尼亚州的 OAT 入院规定比联邦规定更为严格。
确定 OAT 对所有接受治疗的患者的成本效益，与向加利福尼亚州公共资助治疗机构就诊的阿片类药物使用障碍患者的观察标准进行比较。
基于模型的成本效益分析。
加利福尼亚州（2006 年至 2010 年）治疗和刑事司法记录的人群水平行政数据库；已发表的文献。
最初接受公共资助治疗阿片类药物使用障碍的患者。
终生。
社会视角。
所有接受治疗的患者立即获得美沙酮 OAT 治疗，与观察标准进行比较（54.3%的患者接受医学管理的戒断治疗开始阿片类药物使用障碍治疗）。
折扣后的质量调整生命年（QALY）和折扣成本。
所有接受治疗的患者立即获得 OAT 治疗的费用较低（低 78257 美元），并且患者获得的 QALY 更多（增加 0.42），而不是采用观察标准。在一个假设的情景中，2014 年开始治疗阿片类药物使用障碍的所有加利福尼亚人都可以立即获得 OAT，那么该队列的终身总节省可能高达 38 亿美元。
2000 次模拟中的 99.6%导致了更低的成本和更多的 QALY。
OAT 或医学管理戒断的非随机提供。
当 OAT 提供给所有接受治疗的患者时，加利福尼亚州公共资助的阿片类药物使用障碍治疗的价值最大化，提供了比观察标准更大的健康益处和成本节约。
国家药物滥用研究所。
