Cost-effectiveness simulation models can guide and inform clinical and public health responses to the opioid crisis and can be used to improve complex decision making about opioid policy. Despite the strong evidence base for individual interventions that address these priorities, policy makers need guidance on how to combine them while ensuring an efficient use of limited resources.
We find that all economic evaluation using a simulation approach focused on 2 areas: pharmacologic treatments and harm reduction though naloxone distribution. The cost-effectiveness of interventions focused on prevention (eg, prescription drug monitoring programs), recovery support (eg, social supports), and harm reduction approaches other than naloxone (eg, safe injection facilities) has not yet been evaluated using simulation modeling.
We find that that no model to date has considered the economic impact of a combination of interventions in the continuum of opioid use disorder prevention, harm reduction, and treatment. Accounting for synergy between interventions would provide guidance on the optimal allocation of resources for communities facing specific challenges relating to opioid misuse. This is a priority area for health economic research on opioid misuse.
Several evidence-based interventions exist for people who misuse opioids, but there is limited guidance on optimal intervention selection. Economic evaluations using simulation modeling can guide the allocation of resources and help tackle the opioid crisis. This study reviews methods employed by economic evaluations using computer simulations to investigate the health and economic effects of interventions meant to address opioid misuse.
We conducted a systematic mapping review of studies that used simulation modeling to support the economic evaluation of interventions targeting prevention, treatment, or management of opioid misuse or its direct consequences (ie, overdose). We searched 6 databases and extracted information on study population, interventions, costs, outcomes, and economic analysis and modeling approaches.
Eighteen studies met the inclusion criteria. All of the studies considered only one segment of the continuum of care. Of the studies, 13 evaluated medications for opioid use disorder, and 5 evaluated naloxone distribution programs to reduce overdose deaths. Most studies estimated incremental cost per quality-adjusted life-years and used health system and/or societal perspectives. Models were decision trees (n = 4), Markov (n = 10) or semi-Markov models (n = 3), and microsimulations (n = 1). All of the studies assessed parameter uncertainty though deterministic and/or probabilistic sensitivity analysis, 4 conducted formal calibration, only 2 assessed structural uncertainty, and only 1 conducted expected value of information analyses. Only 10 studies conducted validation.
Future economic evaluations should consider synergies between interventions and examine combinations of interventions to inform optimal policy response. They should also more consistently conduct model validation and assess the value of further research.
Economic evaluation of interventions to address opioid misuse
A systematic review of methods used in simulation modeling studies