title: A pharmaceutical industry perspective on the economics of treatments for alcohol and opioid use disorders.
abstract: Individuals with alcohol and/or drug use disorders often fail to receive care, or evidence-based care, yet the literature shows health economic benefits. Comparative effectiveness research is emerging that examines approved approaches in terms of real, total healthcare cost/utilization. Comprehensive retrospective insurance claims analyses are few but tend to be nationally distributed and large. The emerging pattern is that, while treatment in general is cost effective, specific therapeutics can yield different health economic outcomes. Cost/utilization data consistently show greater savings with pharmacotherapies (despite their costs) versus psychosocial treatment alone. All FDA-approved addiction pharmacotherapies (oral naltrexone, extended-release naltrexone, acamprosate, disulfiram, buprenorphine, buprenorphine/naloxone, and methadone) are intended for use in conjunction with psychosocial management, not as stand-alone therapeutics; hence, pharmacotherapy costs must offer benefits in addition to abstinence alone or psychological therapy. Patient persistence is problematic, and (despite its cost) extended-release pharmacotherapy may be associated with lower or no greater total healthcare cost, mostly due to reduced hospitalization. The reviewed studies use rigorous case-mix adjustment to balance treatment cohorts but lack the randomization that clinical trials use to protect against confounding. Unlike trials, however, these studies can offer generalizability to diverse populations, providers, and payment models--and are of particular salience to payers.
authors.affiliation: Treatment Research Institute, Philadelphia, Pennsylvania.
authors.forename: David R
authors.initials: DR
authors.lastname: Gastfriend
mesh_terms: D000427:Alcohol Deterrents / Q000191:economics / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D054563:National Institute on Alcohol Abuse and Alcoholism (U.S.); D054577:National Institute on Drug Abuse (U.S.); D058850:Opiate Substitution Treatment / Q000191:economics; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D017410:Practice Guidelines as Topic; D057285:Precision Medicine / Q000191:economics; D024382:Professional Role; D011613:Psychotherapy / Q000191:economics; D014481:United States; D000078329:Workforce
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists
keywords: agonist; antagonist; comparative effectiveness research; cost effectiveness; medication; pharmaceutical industry; substance abuse