OBJECTIVES : To evaluate the cost-effectiveness of a prescription digital therapeutic (PDT) for opioid use disorder (OUD).

METHODS : The incremental cost-effectiveness ratio (ICER) of PDT+ treatment-as-usual (TAU) vs. TAU was calculated as the difference in direct costs (PDT cost + TAU + health care resource utilization (HCRU)-related cost vs. TAU + HCRU) incurred over 12 weeks between the two treatment strategies, divided by the difference in buprenorphine treatment retention rate at 12 weeks. PDT cost was assumed to be $1,500. TAU cost was derived from the sum of its individual components over 12 weeks (Office visits (6*$33) + urinalyses (36*$70), + buprenorphine 3*$123: $3,086 total). HCRU costs were obtained from an analysis of claims data that showed lower costs over 12 weeks in adherent vs. non-adherent patients ($3,887 vs. $11,219, respectively). HCRU costs were weighted to account for the retention difference observed in the PDT’s pivotal clinical trial (PDT+TAU 80%; TAU 64%) by ascribing adherent costs to retained patients, and non-adherent costs to non-retained patients using the following formula: HCRU_treatment = HCRUCost_Adherent × Retention_treatment + HCRUCost_Nonadherent × (1 – Retention_treatment). A Monte Carlo simulation was performed with 1,000 iterations. Probabilistic sensitivity analysis was performed to estimate the probability that PDT+TAU would be considered cost-effective at various willingness-to-pay thresholds.

RESULTS : The ICER for PDT+TAU was $18.70 per 1 percentage-point increase in retention. The probability that reSET-O would be considered cost-effective was greater than 92% for third party payers with willingness-to-pay thresholds of $6,000 or more for a one percentage-point increase in the buprenorphine treatment retention rate.

CONCLUSIONS : The addition of this PDT to treatment-as-usual may be cost-effective for increasing OUD treatment retention rates. Better retention has elsewhere been associated with improved clinical and humanistic patient outcomes.