Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California

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.

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.