title: Cost-effectiveness of extended release naltrexone to prevent relapse among criminal justice-involved individuals with a history of opioid use disorder.
abstract: OBJECTIVE
  Criminal justice-involved individuals are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended-release naltrexone (XR-NTX; Vivitrol®) in preventing opioid relapse among criminal justice-involved US adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost-offsets. Our aims were to (1) estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence.
  
  
  METHODS
  Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks.
  
  
  METHODS
  Five study sites in the US Northeast corridor.
  
  
  METHODS
  A total of 308 participants were randomized to XR-NTX (n = 153) or TAU (n = 155).
  
  
  METHODS
  Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively.
  
  
  RESULTS
  The 25-week cost per QALY and abstinent-year figures were $162 150 and $46 329, respectively. The 78-week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered 'good value' at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks.
  
  
  CONCLUSIONS
  While extended-release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally accepted value thresholds for QALYs, due to the high price of the injection.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.affiliation: Departments of Population Health, Medicine, Division of General Internal Medicine and Clinical Innovation, New York University, New York, NY, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Baystate Health, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.affiliation: Friends Research Institute, Baltimore, MD, USA.|School of Criminal Justice, University of Baltimore, Baltimore, MD, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Kinlock
authors.affiliation: New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
authors.affiliation: School of Law, University of Virginia, Charlottesville, VA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bonnie
authors.affiliation: Friends Research Institute, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gordon
authors.affiliation: Center for Biomedical Ethics and Humanities, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Donna T
authors.initials: DT
authors.lastname: Chen
authors.affiliation: Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Tamara Y
authors.initials: TY
authors.lastname: Boney
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data; D003416:Criminal Law; D057237:Criminals / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics* / Q000627:therapeutic use; D009511:New England; D009293:Opioid-Related Disorders / Q000191:economics* / Q000517:prevention & control*; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; C000624616:vivitrol; D009271:Naltrexone
keywords: Cost-effectiveness; criminal justice populations; extended release naltrexone; opioid use disorder; quality-adjusted life-years; time abstinent