Presentation (CTI)

OBJECTIVES: Incarcerated individuals with opioid use disorder (OUD) face a high risk of overdose following community reentry. Extended-release naltrexone (XR-NTX) administered prior to release from incarceration, and combined with referral to community-based care, has demonstrated effectiveness for improving OUD outcomes during this critical period; however, medication adherence has been problematic. A recent randomized clinical trial among incarcerated individuals receiving XR-NTX prior to release, tested the effectiveness of a mobile intervention where the individual’s subsequent injections were administered at their place of residence, versus the traditional model of referral to care. Given the enormous personal, public-health, and economic burden of inadequately treated OUD, evaluating the cost-effectiveness of this intervention is essential.
METHODS: A prospective cost-effectiveness analysis was conducted alongside the aforementioned trial from a healthcare sector perspective. Participants were randomized to standard XR-NTX+referral (n=62), or enhanced XR-NTX with mobile medical treatment (n=64) at the participant’s residence. Outcomes were assessed over a 7-month intervention and 8-month total study period (i.e., intervention+follow-up). Effectiveness was measured using quality-adjusted life years (QALYs) and opioid-free years (OfY). Healthcare costs included intervention, non-study medical, and OUD-related costs. Adjusted mean costs and effectiveness were estimated using generalized linear models.
RESULTS: Enhanced XR-NTX was associated with lower OUD-related healthcare costs during the intervention period (−$3,022; p<.001) and over the full study period (−$2,958; p<.001). Total healthcare costs were higher for enhanced XR-NTX in both periods, though differences were not statistically significant. Enhanced XR-NTX participants experienced fewer QALYs, but additional OfYs; however, neither was statistically significant. Across all willingness-to-pay thresholds, enhanced XR-NTX had a low probability of cost-effectiveness based on QALYs, but was cost-effective in approximately 80% of bootstrap replications at willingness-to-pay values exceeding $200,000/OfY.
CONCLUSIONS: While standard XR-NTX was favored in QALY-based analyses, enhanced XR-NTX may offer value for decision makers prioritizing opioid abstinence, highlighting the importance of outcome-specific perspectives.