The Value of Shorter Initial Opioid Prescriptions: A Simulation Evaluation

Area of Science:

• Public Health
• Health Economics
• Pharmacoeconomics

Background:

• The US experienced over 350,000 overdose deaths from prescription opioids between 1999 and 2016.
• Policy interventions targeting prescriber behavior, like CDC guidelines, aim to reduce opioid overuse.
• The economic and health impacts of these interventions require further quantification.

Purpose of the Study:

• To quantify the economic and health-related efficacy of a policy intervention.
• To assess the impact of reducing the duration of initial opioid prescriptions.

Main Methods:

• A Markov decision process model was developed using a retrospective cohort of 827,265 US Army soldiers (2011-2014).
• Patient cost and health trajectories were simulated over a 24-month period.
• Propensity score matching was used to compare patients with short (≤3 days) versus long (>7 days) initial opioid prescriptions.

Main Results:

• Reassigning 10,000 patients to short initial prescriptions could save approximately $3.1 million over two years.
• This policy change is associated with an estimated 4451 additional opioid-free months.
• The cost per quality-adjusted life-year (QALY) gained indicates a cost-effective intervention.

Conclusions:

• Policy interventions aimed at modifying prescriber behavior regarding initial opioid prescription length are cost-effective.
• Further research into implementing such policies is warranted to address the opioid crisis.
• Reducing opioid prescription duration offers significant cost savings and public health benefits.