Cost-effectiveness of technology-assisted buprenorphine for opioid use disorder: Analysis of three randomized trials.

INTRODUCTION: Despite the well-documented efficacy of opioid agonist therapies (e.g., buprenorphine), many individuals with opioid use disorder (OUD) do not receive adequate treatment. Therefore, efforts to expand OUD treatment availability are needed. Prior randomized controlled trials (RCTs) have demonstrated the feasibility and efficacy of technology-assisted buprenorphine (TAB), which utilizes a portable computerized device for medication storage, nightly check-in calls, computer-generated random call-backs and iPad-delivered education for overdose and infectious disease prevention. In this analysis, we integrated patient-level data from three RCTs with published health-economic estimates associated with standard community-based OUD treatment and untreated OUD to quantify the cost-effectiveness of TAB treatment. METHODS: Data were pooled from three RCTs comparing TAB to a control condition. Integrating trial results with published literature, we projected the present value gains in quality-adjusted life years (QALYs), health-economic costs and savings associated with the TAB intervention, and the fatal and non-fatal overdoses averted. We generated pooled results with 95% confidence intervals (95% CIs) over the 24-week duration (used in two of the three RCTs) as an average weighted by person years. RESULTS: In each of the three RCTs as well as in the pooled results, TAB treatment improved QALYs and lowered health-sector and societal costs. Pooled QALYs gains were 0.074 (95% CI: 0.059 to 0.090), healthcare cost savings were $3972 (95% CI: $2846 to $5098), and societal cost savings were $22,843 (95% CI: $16,319 to $29,367) per participant. TAB treatment reduced opioid use by 55% in pooled results. Over the trials' durations, TAB treatment was projected to prevent 4-8 nonfatal and 0.4-0.9 fatal opioid overdoses per 1000 patients treated. CONCLUSIONS: Although recent studies in the larger literature have demonstrated the cost-effectiveness of office-based buprenorphine treatment using simulation models, none to our knowledge have examined this for technology-assisted MOUD interventions and few have used data from prospective RCTs. TAB treatment proved cost saving or dominant for all three RCTs and in pooled results. These results expand upon prior findings of intervention efficacy to also provide support for the cost-effectiveness of TAB and its potential for reducing the burden of societal and healthcare costs of OUD.