A model to quantify potential medical events avoided and cost savings from abuse deterrent opioids
Journal of Pain, 2016
A previously published model for estimating potential medical events avoided and cost savings to the United States (US) with the introduction of extended-release (ER) abuse-deterrent opioids (ADOs) was updated by incorporating new methods of estimating abuse deterrence from human abuse liability studies (HALs). An Excel model was developed to estimate reductions in abuse-related events and annual savings for the US. Model inputs included: opioid abuse prevalence, ADO cost and effectiveness and costs associated with opioid abuse-related events. Costs and prevalence were based on published administrative claims database analyses, substance abuse treatment center data, and national surveys. Differences in ADO and non-ADO positive subjective measures scores from HALs were used to estimate reductions in non-medical use (NMU) associated with ADOs. Direct (medical and drug) and indirect (work loss) cost savings (2014 USD) and abuse-related events were estimated assuming the entire ER opioid prescription (brand and generic) market is replaced by ADOs. Most (96%) ER opioid prescriptions (2Q 2013–1Q 2014) are comprised of oxycodone, morphine, transdermal fentanyl, and methadone. Generics comprise 71.4% of all ER opioid prescriptions. Oxycodone consists almost entirely of a branded ADO, whereas others consist almost entirely of generic non-ADOs. Replacing the ER opioid market with ADOs is estimated to avoid annual abuse-related medical events by approximately 13-31% (e.g., 78,000–186,000 emergency department visits) and annual medical cost savings are approximately $550M-$1,300M, depending on ADO technology (physical barrier or agonist/antagonist). Total net savings vary depending upon ADO price relative to the non-ADO generics. Modeling the medical and economic impact of replacing the non-ADO ER opioid market with ADOs resulted in 13%-31% of abuse-related medical events avoided and annual medical cost savings of up to $1.3B. More events are avoided with the agonist/antagonist ADO technology. Total net savings are dependent upon the ADO price relative to non-ADO generics.