Fances Simbulan
Frances Simbulan1,2, Saadia Sediqzadah3,4, Samantha Young1,5, Petros Pechlivanoglou1,2, Dan Werb1,6,7. 1Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; 2Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Canada; 3Department of Psychiatry, St. Michael’s Hospital, Canada; 4Department of Psychiatry, University of Toronto, Canada; 5Division of General Internal Medicine, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Canada; 6Center on Drug Policy Evaluation, St. Michael’s Hospital, Canada; 7Division of Infectious Diseases and Global Public Health, University of California San Diego, United States
Background: There is negligible access to injectable hydromorphone (iHDM) as a medication for opioid use disorder (MOUD) in Ontario, Canada’s most populous province, despite emerging evidence of its clinical benefits and cost-effectiveness. We evaluated the cost-effectiveness of iHDM compared to methadone and sublingual buprenorphine for severe opioid use disorder (OUD) from the Ontario healthcare payer perspective.
Methods: We developed a microsimulation model to simulate a cohort of individuals with severe OUD and evaluated the lifetime impact of the three strategies. Outcomes included opioid-related events and mortality, quality-adjusted life years (QALYs), healthcare costs and incremental cost-utility ratios (ICURs). Deterministic and probabilistic analyses were conducted to assess the uncertainty of input parameters and model structure.
Results: iHDM reduced lifetime cumulative incidence of emergency department visits by 12% and 10%, and opioid-related mortality by 12% compared to methadone and buprenorphine, respectively. iHDM was associated with 1.63 and 0.82 additional QALYs, however, resulted in additional cost of $270,204 and $242,444 compared to methadone and buprenorphine, respectively. The ICUR of buprenorphine was $34,271/QALY compared to methadone and was most likely to be cost-effective at commonly used willingness-to-pay (WTP) of $50,000/QALY. The iHDM ICUR was high, $165,769/QALY and $295,663/QALY when compared to methadone and buprenorphine but may be cost-effective at WTP above $200,000/QALYs.
Conclusions: iHDM improved life years and QALYs. However, it increased healthcare costs compared to oral MOUD. This can help inform decision-making on the value of iHDM for severe OUD in Ontario and other settings. Further evaluations should include a societal perspective, such as criminal involvement and incarceration.