Evaluation of the cost-utility of a prescription digital therapeutic for the treatment of opioid use disorder

Figures & data

Figure 1. Decision analytic model evaluating the cost-effectiveness of reSET-O + TAU vs. TAU (i.e. oral buprenorphine, face-to-face counseling, and CM) alone

CM, contingency management; OUD, opioid use disorder; TAU, treatment-as-usual.Note: TAU includes oral buprenorphine, face-to-face counseling, and contingency management (CM).

Table 1. Clinical and economic model inputs for reSET-O + TAU vs. TAU cost-effectiveness model

	reSET-O + TAU	TAU	Source
Clinical Inputs
Abstinence	75.9%	60.6%	GEE of odds of negative urine drug screen during weeks 9–12 from reSET-O’s pivotal clinical trial population [29,30].
SF-6D Health Utility Values
Population Baseline	0.745		Clinical trial data*
Abstinent	0.784	0.769
Non-Abstinent	0.739	0.743
Health Utility Change from Baseline (week 12) – Abstinent	0.0354	0.0182
Health Utility Change from Baseline (week 12) – Non-Abstinent	0.0323	−0.0217
Economic Inputs
reSET-O	$1,440/prescription	$0	Red Book [34], assumes ~13.5% discount off $1,665 USD WAC
Contingency Management (CM)	Included with reSET-O	$350/12 weeks	[35,36]
Treatment-delivery costs
Office visits	$99/12 weeks	$198/12 weeks	Wang et al., 2020 [27]
Urinalyses	$840/12 weeks	$840/12 weeks
Buprenorphine	$369/12 weeks	$369/12 weeks
Medical Costs
Abstinence	$3,887/12 weeks	$3,887/12 weeks
Non-Abstinence	$11,219/12 weeks	$11,219/12 weeks

*mapped from addiction severity index scores from the reSET-O clinical trial population [29,30]

Table 2. Base case clinical and economic consequences and cost-effectiveness of reSET-O + TAU vs. TAU

	reSET-O + TAU	TAU	Incremental Difference
12-Week Clinical Consequences
% of patients abstinent	75.9%	60.6%	15.3%
Population Health Utility values	0.773	0.759	0.014
QALYs (adjustment for 12 out of 52 weeks)	0.178	0.175	0.003
12-Week Economic Consequences
reSET-O	$1,440	$0	$1,440
CM cost	$0	$350	-$350
Treatment intervention (office visits, urinalyses, and buprenorphine)	$1,308	$1,407	-$99
Medical costs associated with abstinence/lack of abstinence	$5,654	$6,776	-$1,122
Total Costs	$8,402	$8,533	-$131
Cost-effectiveness ($/QALY)			reSET-O Economically Dominant

Table 3. Sensitivity analyses for reSET-O + TAU vs. TAU cost-effectiveness model

Analysis	QALY Difference	Incremental Cost	ICER
Base Case	0.003	-$131	reSET-O Dominant
Use of Utility Change Scores	0.007	-$131	reSET-O Dominant
Population-Derived Utility from the Institute for Clinical and Economic Review^17	0.005	-$131	reSET-O Dominant

Christensen DR, Landes RD, Jackson L, et al. Adding an internet-delivered treatment to an efficacious treatment package for opioid dependence. J Consult Clin Psychol. 2014;82(6):964–972. .

 PubMed Web of Science ®Google Scholar

Maricich YA, Bickel WK, Marsch LA, et al. Safety and efficacy of a prescription digital therapeutic as an adjunct to buprenorphine for treatment of opioid use disorder. Curr Med Res Opin. 2020. DOI:10.1080/03007995.2020.1846022

 Web of Science ®Google Scholar

IBM Micromedex RED BOOK [Internet]. IBM Watson Health™, an IBM Company; c2017. [cited 2019 Feb 20]. Available from: https://www.ibm.com/us-en/marketplace/micromedex-red-book.

 Google Scholar

Sindelar JL, Olmstead TA, Peirce JM. Cost-effectiveness of prize-based contingency management in methadone maintenance treatment programs. Addiction. 2007;102(9):1463–1471.

 PubMed Web of Science ®Google Scholar

Petry NM, DePhilippis D, Rash CJ, et al. Nationwide dissemination of contingency management: the veterans administration initiative. Am J Addict. 2014;23(3):205–210.

 PubMed Web of Science ®Google Scholar

Maricich YA, Xiong X, Gerwien R, et al. Real-world evidence for a prescription digital therapeutic to treat opioid use disorder. Curr Med Res Opin. 2020. DOI:10.1080/03007995.2020.1846023

 Web of Science ®Google Scholar