Modeling the potential impact of abuse-deterrent opioids on medical resource utilization

Figures & data

Figure 1. Estimated reductions in non-medical use. Abbreviations. ADO, abuse-deterrent opioid; E_max, mean maximum effect; NMU, non-medical use; NSDUH, National Survey on Drug Use and Health. This figure reflects calculation steps for agonist/antagonist ADOs only. Physical barrier ADOs have a drug liking E_max of 80.4 mm, resulting in a 12.7% reduction in predicted NMU rate. The difference in drug liking E_max was converted to point reductions in NMU according to White et al.¹² and used to calculate the percent reduction in predicted NMU rate. Notes: (1) ‘mm’ represents millimeters, which are one unit on the Drug Liking scale measured from 0–100. (2) The 30.6 percent reduction in the predicted NMU rate associated with replacement of a non-ADO with an ADO is calculated by dividing the predicted percentage point reduction in the NMU rate associated with replacement of a non-ADO with an ADO (∼0.43 percentage points) by the NMU rate associated with non-ADO as reported by the NSDUH (∼1.40 percentage points).

Table 1. Key model inputs.

Input	Low scenario^a	High scenario^b	Source
Reduction in NMU rate	12.7% decline in NMU (physical barrier)	30.6% decline in NMU (agonist/antagonist)	White et al.^12
Diversion	15% of overall avoided events and costs	15% of overall avoided events and costs	Rice et al.^21, Yenikomshian et al.^10
Medical savings for oxycodone ER (Inflated to 2017 USD)	$515m	$1,236m	Rossiter et al.^9
Overall number of opioid related ED visits before ADO introduction	600,000	600,000	NIDA^16

^a Low scenario refers to the replacement of non-ADOs with ADOs with physical barrier technology.

^b High scenario refers to the replacement of non-ADOs with ADOs with agonist/antagonist technology.

Abbreviations. ADO, abuse-deterrent opioid; ER, extended-release; NIDA, National Institute on Drug Abuse; NMU, non-medical use.

Table 2. Estimated annual avoided medical events and costs.^a

		ER morphine		TD fentanyl
		Low scenario^b	High scenario^c	Low scenario	High scenario
Avoided events	ED visit	17,848	42,916	745	1,791
	Outpatient visit	183,803	441,954	7,673	18,449
	Hospitalizations	11,820	28,422	493	1,186
	Substance abuse treatment	3,073	7,390	128	308
	Opioid abuse drug treatment	48,699	117,097	2,033	4,888
	Injection-related diseases	3,045	7,321	63	153
Cost savings (millions of 2017 USD)	Direct: Medical	$120.63	$290.06	$4.88	$11.74
	Direct: Prescription drugs	$13.87	$33.36	$0.47	$1.12
	Indirect: Work loss	$29.35	$70.57	$1.23	$2.95
	Direct/indirect cost savings	$163.85	$393.99	$6.58	$15.81

^a Annual avoided medical events and costs were estimated over a 1-year time period for ER morphine and TD fentanyl for both low and high scenarios.

^b Low scenario refers to the replacement of non-ADOs with ADOs with physical barrier technology.

^c High scenario refers to the replacement of non-ADOs with ADOs with agonist/antagonist technology.

Abbreviations. ADO, abuse-deterrent opioid; ED, emergency department; ER, extended-release; TD, transdermal.

Table 3. Overall medical cost savings and avoided ED visits.

Opioid	Low scenario^a		High scenario^b
	Annual medical cost savings	Annual avoided ED visits	Annual medical cost savings	Annual avoided ED visits
ER morphine	$120m	17,848	$290m	42,916
TD fentanyl	$5m	745	$12m	1,791
ER oxycodone^c	$515m	59,407	$1,236m	141,293
Total	$640m	78,000	$1,538m	186,000

^a Low scenario refers to the replacement of non-ADOs with ADOs with physical barrier technology.

^b High scenario refers to the replacement of non-ADOs with ADOs with agonist/antagonist technology.

^c Medical cost savings for oxycodone were calculated from Rossiter et al.⁹. Avoided ED visits were calculated based on the total annual number of avoided ED visits from NIDA (2009). See also Table 1.

Abbreviations. ADO, abuse-deterrent opioid; ED, emergency department; ER, extended-release; NIDA, National Institute on Drug Abuse; TD, transdermal.

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