Using Economic Evaluation to Inform Responses to the Opioid Epidemic in the United States: Challenges and Suggestions for Future Research

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Table 1. Recommendations for future research and policy involving economic evaluations to guide responses to the opioid epidemic in the US.

Challenge 1	The magnitude and geographical distribution of the opioid epidemic across fragmented health care systems
Recommendation 1	Need for a central body with a formal mandate to coordinate research efforts in the conduct of economic evaluations of health technologies addressing OUD (e.g. medications), to inform decisions among government funded programs across the whole country.
Recommendation 2	Pragmatic approach from researchers considering critical areas, namely the development of generic models and their application to inform resource allocation by state Medicaid organizations and local health departments.
Challenge 2	The intersection of multiple epidemics
Recommendation 1	Implement an integrated health care perspective with “whole disease” models of OUD, which consider disease manifestations at different stages of progression  and interventions at primary, secondary and tertiary levels to identify optimal combination.
Recommendation 2	Build on methodological research to develop models concerned with the multiple comorbidities (i.e. OUD, mental health disorders, HIV, and HCV).
Challenge 3	The rapidly changing dynamics of the opioid epidemic
Recommendation 1	Further research and implementation of new methods for indirectly estimating OUD prevalence (e.g. capture-recapture and methods which combine data from multiple sources).
Recommendation 2	Integrate economic evaluation with predictive modeling approaches from epidemiological research to evaluate surveillance systems, epidemic preparedness investments, and the scale up of emergency interventions.
Challenge 4	The multi-sectoral causes and consequences of opioid use disorder
Recommendation 1	Economic evaluations of upstream/structural programs/interventions to address economic and social determinants as the root cause of OUD are needed.
Recommendation 2	Disaggregated presentation of upstream program costs and consequences by sector to facilitate negotiations amongst decision makers for various sectors.