A Review of Health Economic Modeling Challenges for Opioid Use Disorder Treatment in Prison Settings
Author(s)
Tushar Srivastava, MSc1, Shashwat Gaur, MSc2, Anurag Gupta, MSc2, Saeed Anwar, MPharm2, Madhusudan Kabra, MSc3, Raju Gautam, PhD1.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3MK Global Consulting, London, United Kingdom.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3MK Global Consulting, London, United Kingdom.
OBJECTIVES: Opioid use disorder (OUD) poses a substantial burden on healthcare systems, with incarcerated populations experiencing higher OUD prevalence and limited access to treatment. Modeling OUD treatment in prisons is challenging due to dynamic prison systems, data limitations, and ethical complexities. This study aims to identify key challenges in modeling OUD treatment in prison settings.
METHODS: A targeted literature review was conducted using PubMed and Google scholar, published between data-inception to May 2025. Studies were included if they reported economic modelling for OUD treatment in prison settings.
RESULTS: The search retrieved 214 citations, of which 16 studies met the inclusion criteria. The majority were conducted in the USA (11/16; 70%). 15 studies (94%) were cost effectiveness analysis (CEA) and one was cost analysis. 10 out of 15 CEA reported model structures, among state transition model (40%) was the most common model structure. Most studies (7/10; 70%) adopted a societal perspective. A short time horizon, ranging from 24 weeks to 1 year (4/10; 40%) was used in models. Key challenges identified included inadequate model structure (60%), driven by the dynamic nature of prison entry and release, high turnover rates, and transitions between correctional and community care. Other challenges were lack of evidence or data sources, short time horizons that are difficult to capture long-term outcomes like abstinence and remission, and unrealistic assumptions that may not reflect real-world conditions, leading to biased results.
CONCLUSIONS: This study highlights that modeling OUD treatment in prison settings encounter several methodological and practical challenges related to data availability and system complexity. Addressing these gaps requires improved data availability, stakeholder engagement, and models that reflect real-world care pathways. Future research should aim to standardize economic evaluation frameworks for correctional settings to better inform decision-making and improved access to evidence-based OUD treatment in prison settings.
METHODS: A targeted literature review was conducted using PubMed and Google scholar, published between data-inception to May 2025. Studies were included if they reported economic modelling for OUD treatment in prison settings.
RESULTS: The search retrieved 214 citations, of which 16 studies met the inclusion criteria. The majority were conducted in the USA (11/16; 70%). 15 studies (94%) were cost effectiveness analysis (CEA) and one was cost analysis. 10 out of 15 CEA reported model structures, among state transition model (40%) was the most common model structure. Most studies (7/10; 70%) adopted a societal perspective. A short time horizon, ranging from 24 weeks to 1 year (4/10; 40%) was used in models. Key challenges identified included inadequate model structure (60%), driven by the dynamic nature of prison entry and release, high turnover rates, and transitions between correctional and community care. Other challenges were lack of evidence or data sources, short time horizons that are difficult to capture long-term outcomes like abstinence and remission, and unrealistic assumptions that may not reflect real-world conditions, leading to biased results.
CONCLUSIONS: This study highlights that modeling OUD treatment in prison settings encounter several methodological and practical challenges related to data availability and system complexity. Addressing these gaps requires improved data availability, stakeholder engagement, and models that reflect real-world care pathways. Future research should aim to standardize economic evaluation frameworks for correctional settings to better inform decision-making and improved access to evidence-based OUD treatment in prison settings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE30
Topic
Economic Evaluation, Study Approaches
Disease
Mental Health (including addition)