Abstract for: Cost-Effectiveness of Interventions to Increase Buprenorphine Treatment Capacity, Initiation, and Duration: A Modeling Analysis
Buprenorphine is an effective medication for opioid use disorder that can be prescribed and taken at home. We conducted a cost-effectiveness analysis to compare the addition of contingency management and psychotherapy to buprenorphine treatment and increasing the reach of hub and spoke provider training programs. We modeled the effects of each intervention with the Simulation of Opioid Use, Response, Consequences, and Effects (SOURCE), a system dynamics model of opioid and heroin use, treatment, and remission in the United States, calibrated to data from 1999-2020. We found that telehealth averted 8,650 overdose deaths, more than any other single-intervention strategy. However, interventions that increased the duration of buprenorphine initially increased the number of overdose deaths due to insufficient capacity. The portfolio with contingency management, hub and spoke training, ED initiation, and telehealth was the most cost-effective strategy with an incremental cost-effectiveness ratio of $8,607 per quality-adjusted life year (QALY) gained (2021 USD). When expanding buprenorphine treatment in the U.S., strategies to increase treatment duration, treatment initiation, and the sustained capacity of buprenorphine treatment at the same time avert the most overdose deaths and are the most cost-effective.