ISSUE BRIEF

 Estimating the Net Economic Benefit of Abuse-Deterrent Opioids

 Wayne Winegarden, Ph.D.

Contributing Editor, EconoSTATS at George Mason University

Sr. Fellow in Business and Economics, Pacific Research Institute

 March 2015

Findings in Brief

  • Chronic pain is a large health burden in the United States.  Estimates show that the costs of chronic pain are as much as $635 billion a year.  Opioids are an important tool that helps patients manage their pain more effectively, and helps reduce the costs of chronic pain.
  • However, the abuse and diversion of opioids has created an unintended problem.  These health care and societal costs have been estimated at $55.7 billion a year.
  • Abuse-deterrent opioid analgesics are an important technology that can help reduce the large costs created by opioid abuse while still ensuring pain patients receive their medicines.
  • This issue brief estimates the net economic benefit of abuse-deterrent opioids.  The net economic benefit estimated in this brief ranges between $1,757 per patient and $4,033 per patient, depending upon price and insurance coverage assumptions.

 

Effectively managing pain is a necessary medical treatment for millions of Americans.  Medicines, such as opioids, are an important treatment that helps patients better manage their pain.  However, there are unintended consequences from these drugs.  The diversion and abuse of opioid medication imposes economic and societal costs including: higher medical expenditures; increased criminal activity; and, lost worker productivity. 

In response to these costs, pharmaceutical products have been developed that contain abuse-deterrent properties.  If these abuse-deterrent opioid analgesics work as intended, then the costs associated with the abuse of pain medication will be lower. 

The purpose of this brief is to review the potential positive impact that abuse-deterrent opioids can have on reducing the costs associated with the abuse of pain medications (the benefit of abuse-deterrent opioids) and compare these potential benefits to the estimated higher prices of abuse-deterrent opioids. 

The next section of the paper overviews the estimated costs of pain.  Once the large costs of pain has been reviewed, the estimated costs from the abuse and diversion of pain medications are presented.  The cost estimates provide a sense of how large the problem of opioid diversion and abuse is, and illustrate the potential benefits from technological solutions. 

The potential benefit of abuse-deterrent opioids to address the problem is presented next.  These benefits are based on studies that have examined the impact abuse-deterrent opioids have on reducing the abuse and diversion of opioid medications.

However, currently these additional benefits come with additional costs. While many opioids without abuse-deterrent properties are available in generic versions, this is not the case for abuse-deterrent opioids.  Consequently, the average costs of abuse-deterrent opioids are expected to be higher than the average costs of opioids without abuse-deterrent properties.  To develop the potential net economic benefit from abuse-deterrent opioids, the benefits are then compared to an estimate of their expected higher average costs.  The results from these calculations are presented as the net economic benefit from abuse-deterrent opioids.

The Costs of Chronic Pain

Chronic pain afflicts a large percentage of the U.S. population, and the debilitating nature of chronic pain has been well documented.  The aggregate dollar costs of chronic pain are estimated at more than $635 billion, which does not fully account for patients’ pain and suffering; nor the estimated costs from the abuse of pain medications.[1]  Additionally, more than 100 million American adults are estimated to be afflicted with some level of chronic pain.[2] 

Patients suffering from chronic pain spend more money on health care than people not suffering from chronic pain.  Health care costs are higher due to larger numbers of emergency room visits, higher amounts of other hospital expenditures, higher medication costs, and higher psychological costs such as the treatment of depression that result from the inability to properly treat pain.  The majority of these health care costs are directly borne by payers (e.g. private health insurance companies and public health insurance programs).  Of the $635 billion in total costs from chronic pain, additional healthcare costs associated with chronic pain compared to a patient without chronic pain are estimated to be between $261 billion and $300 billion.[3]

The higher healthcare costs, and potential healthcare savings due to effective pain treatment, are also evident on a per patient basis.  According to an Institute of Medicine study:

Pain prevention…offers the prospect of substantial savings in U.S. health care costs. The analysis conducted for this study found that on average, a person with moderate pain generates health care expenditures $4,516 higher than those for a person without pain. A person with severe pain generates health expenditures $3,210 higher than those for a person with moderate pain. The precise reasons for these large cost differences are unclear; to the extent that they reflect differential utilization of health services due to pain, however, the potential cost savings if pain were prevented or treated more effectively are enormous.[4] 

The other major category of costs from chronic pain is due to the lost productivity of chronic pain sufferers.  These costs are imposed on the person suffering from chronic pain as well as the businesses where they work.[5]  Of the $635 billion in total costs from chronic pain, lost productivity costs accounted for $299 billion to $335 billion.

Stewart and Ricci (2003) estimated the costs of chronic pain on productivity due to employee absenteeism and the reduced productivity of employees who reported to work but were in pain.[6]  The majority (76.6%) of the measured productivity losses were due to reduced performance while at work.

Market expenditures on chronic pain management is also large, and growing.  For instance, the pain management drugs and devices market was $35.4 billion in 2012, and is expected to grow 3.2 percent a year reaching $41.5 billion in 2017.[7] Additionally, a 2007 survey by the National Center for Health Statistics found that Americans spent $34 billion on complementary and alternative medicines (such as chiropractors and acupuncture) in a single year – 9 of the top 20 conditions contained in the survey involved chronic pain.[8]

These studies and data indicate that pain is a costly affliction, and that medical treatment is highly valued by those who are suffering.  Opioids and other prescription pain medications are designed to help pain patients manage their conditions and thereby reduce these estimated costs from pain. 

 The Costs of Opioid Abuse

While opioids provide benefits with respect to managing pain, the diversion and abuse of opioids imposes large economic and societal costs.  Often, the abuse of pain medications results from family members abusing medicine that was legally prescribed to another family member.  According to the CDC, more than 16,000 people die every year from overdoses involving pain medication and 1 in 20 people in the U.S. age 12 and older reported using prescription pain medicines for nonmedical reasons.[9]

Individuals abusing pain medication incur higher healthcare costs compared to individuals who do not abuse pain medication.  According to a study by White et al. (2005), the “mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively…)”.[10]  It is not just higher healthcare costs, however.  Individuals who abuse pain medication are also less productive at work, creating workplace costs.  Abusers create higher criminal justice costs as well.

The combination of higher costs caused by individuals abusing pain medication, coupled with the large number of individuals abusing these medicines, has led to a large aggregate cost from opioid abuse.  Birnbaum et al. (2011) estimate that “total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (the estimates are reported in 2009 dollars).  Workplace costs accounted for $25.6 billion (46%), health care costs accounted for $25.0 billion (45%), and criminal justice costs accounted for $5.1 billion (9%).”[11]

The Birnbaum et al. findings are typical according to a comprehensive review of the literature performed by Strassels (2009).[12]  Strassels (2009) examined 41 papers in detail that assessed the economics and epidemiology of prescription opioid abuse or misuse in the United States.[13]  According to Strassels the literature finds that, “the costs associated with opioid abuse and misuse are large and represent a significant societal burden. While efforts to decrease the epidemiologic and economic burden of opioid misuse and abuse are important, pain is commonly poorly managed in the United States. Thus, it is important to ensure that efforts to reduce opioid abuse and misuse do not adversely affect appropriate access to these drugs for pain management.” [14]

The abuse of opioid medications is not only a large problem, it is a growing problem.  According to the U.S. Department of Health and Human Services, “Opioid analgesics were involved in 30% of drug overdose deaths where a drug was specified in 1999, compared to nearly 60% in 2010. Opioid-related overdose deaths now outnumber overdose deaths involving all illicit drugs such as heroin and cocaine combined.  In addition to overdose deaths, emergency department visits, substance treatment admissions and economic costs associated with opioid abuse have all increased in recent years.”[15]

As another example, Moorman-Li et al. (2012) found that the problem of opioid abuse is growing, stating that “abuse rates having quadrupled in the decade from 1990 to 2000.’[16]

The Potential Role of Abuse-Deterrence Technology in Reducing the Costs of Opioid Abuse 

There are several practices currently used to reduce opioid misuse and abuse.  While noting that a combination of tools may be necessary because no one tool can work all of the time, the FDA (2013), Strassels (2009), and Hahn (2011) noted the following practices have been used for the purpose of reducing the diversion and abuse of opioid medications:[17]

  • Physician and patient education regarding these medications and their associated risks for abuse;
  • Prescription monitoring programs to detect physician or pharmacy shopping and inappropriate prescriptions;
  • Multi-copy or serially numbered prescriptions;
  • The use of physician–patient contracts;
  • Photo identification requirements to pick up an opioid prescription;
  • Urine drug toxicology screening;
  • Provisions for safe disposal of unused opioids;
  • Clinical questionnaires and screening tools to identify individuals at risk for misusing or abusing opioid analgesics;
  • Enhanced efforts to monitor controlled substances from manufacturer to pharmacy to reduce theft during the distribution process; and,
  • Developing and encouraging the use of opioid formulations aimed at reducing abuse and that resist common methods of tampering.

The last approach, abuse-deterrent opioids, is a relatively new and dynamic approach for managing the opioid abuse problem.  For instance, three new abuse-deterrent drugs have been approved in the last year and several new technologies and medicines (both branded and generic) are currently under development.  Hahn (2011) explains that abuse-deterrent opioids work in one of three general approaches:

  • The “fortress approach,” in which the formulation maintains its extended-release characteristics despite attempts to crush or dissolve it
  • The “neutralizing approach,” in which the formulation is relatively easy to alter, but tampering with the formulation results in the release of a neutralizing antagonist
  • The “aversive approach,” in which the opioid is formulated with an aversive agent that results in un-pleasant side effects when a large quantity of the opioid is ingested.[18]

Whether there is a net benefit from using abuse-deterrent opioids depends upon the additional benefit created by abuse-deterrent opioids (e.g. the reduction in abuse and misuse) compared to any additional costs.  Estimating the net benefit from abuse-deterrent opioids requires a measurement of the reduced economic, health, and societal costs from opioid abuse (the benefits) and a measurement of any additional costs of abuse-deterrent opioids compared to current opioid therapies.

Most abuse-deterrent opioids have been approved recently, therefore, the impact from abuse-deterrent opioids on reducing opioid abuse and diversion is a new research field.  However, as should be expected with new technologies, studies of the effectiveness of abuse-deterrent opioids are starting to be published.  These studies are illustrating that abuse-deterrent opioids are associated with reductions in abuse and misuse, and that abuse-deterrent opioids are having a positive benefit with respect to the costs of the opioid abuse problem. 

Rossiter et al. (2014) estimated how the introduction of an extended-release (ER) version of oxycodone HCI with abuse-deterrent technology changed medical costs.[19]  The authors found that “the introduction of reformulated ER oxycodone was associated with relative reductions in rates of diagnosed opioid abuse of 22.7% and 18.0% among commercially-insured and Medicaid patients, respectively.”[20]  Rossiter et al. (2014) also found that the excess annual per-patient medical costs associated with diagnosed opioid abuse were $9,456 for commercially-insured patients and $11,501 for Medicaid-insured patients.[21]  The authors found that “overall, reformulated ER oxycodone was associated with annual medical cost savings of $430 million in the US.” [22]

However, Kirson et al. (2014) note that the “medical cost savings reported in Rossiter et al. are an underestimate of the full societal economic benefits of reformulated ER oxycodone, as prescription opioid abuse is also associated with higher rates of medical resource utilization and costs among caregivers and substantial workplace and criminal justice costs.”[23]  Kirson et al. (2014) label these indirect cost savings.  In total, they estimate that abuse-deterrent opioids could reduce indirect costs by $605 million, for a total cost reduction from reformulated ER oxycodone (including medical costs) of $1.04 billion.[24]

The estimated $1.04 billion in reduced medical and indirect costs associated with the abuse of opioid medications represents a large benefit that abuse-deterrent opioids can create.  The figure does not account for any additional expenditures that must be incurred in order to obtain these benefits, however (a cost-benefit calculation). 

A cost-benefit calculation requires the additional benefits gained to be compared to the estimated additional costs of abuse-deterrent opioids.  Currently, abuse-deterrent opioids cost more because these drugs are still on patent, while many non-abuse-deterrent opioid drugs have generic alternatives available.  The estimated additional cost of abuse-deterrent opioids is the additional outlays required because more patients are being transitioned from cheaper generic opioids without abuse-deterrent properties to more expensive patented abuse-deterrent drugs.

While there are still many unknowns,[25] an estimated cost-benefit analysis can be created using Rossiter et al. (2014) and Kirson et al. (2014) as a proxy for the potential benefits of abuse-deterrent opioids, and using the difference in price between generic opioids and patented opioids as a proxy for the potential higher costs of abuse-deterrent opioids. 

Starting with the benefits, the results from Rossiter et al. (2014) and Kirson et al. (2014) are converted to a per-opioid patient basis in order to compare the benefits per patient to the cost per patient. 

Starting with the calculation of benefit per patient, the last two columns in Table 1 rows (1) and (2) present the findings from Rossiter et al. (2014) – abusers of extended-release opioid (ERO) medications have excess annual health care costs of $9,456 and $11,501 for commercially insured patients and patients on Medicaid/uninsured patients, respectively.[26]  The study also found that the specific abuse-deterrent opioid examined (reformulated ER oxycodone) reduced the rate of diagnosed opioid abuse by 22.7 percent and 18.0 percent, respectively. 

However, to obtain these benefits, the abuse-deterrent opioid needs to be provided to the entire population.  Therefore the potential cost savings between $9,456 and $11,501 needs to be weighted by the reduction in the rate of diagnosed opioid abuse.  The “Benefit per Opioid Patient” column in Table 1 presents this result, which is simply the multiplication of the percentage reduction in opioid abuse and the additional health care costs of abusers.  Therefore, abuse-deterrent opioids provide $2,147 in net health care benefits per opioid patient to the commercially-insured population and $2,070 in net health care benefits per opioid patient to the Medicaid eligible/uninsured patients.

As Kirson et al. (2014) illustrate, the overall benefits also include reductions in workplace costs, criminal justice costs, and caregiver costs.  Based on the total population in Rossiter et al. (2014), Table 1 adjusts the total estimated indirect (or non-health related) costs of $605 million to a per abuser basis by dividing the aggregate costs by the number of patients the total population in Rossiter et al. (2014).  This figure equals $12,414, row (3) in Table 1. 

Weighting the percentage reduction based on the share of commercially insured patients versus Medicaid patients in Rossiter et al. (2014), the net benefit per opioid patient in reduced non-health related costs is $2,498.

The total “benefit per opioid patient” is the addition of the health expense savings and the non-health expense savings.  These results are presented in Rows (4) and (5) of Table 1.  Total savings for commercially insured patients receiving opioid treatment are $4,645; for the Medicaid eligible/uninsured population the total savings are $4,568.

Table 1

Total Annual Benefits per Patient from Abuse-deterrent Opioids

 

 

 

Benefit per Patient

Additional Per-patient Annual Cost Premium of Abusers

Percentage Reduction

(1)

Health expenses commercially-insured

$2,146.51

$9,456

22.70%

(2)

Health expenses Medicaid/Uninsured

$2,070.18

$11,501

18.00%

 

 

 

 

 

(3)

Non-health related expenses

$2,498.26

$12,414

20.1%

 

 

 

 

 

(4)

Total commercially-insured population

$4,644.77

 

 

(5)

Total Medicaid/uninsured population

$4,568.44

 

 

                 

However, all abuse-deterrent opioids that are currently on the market are patented products compared to many generic versions of opioids that are currently on the market.  Therefore, the average price of abuse-deterrent opioids will be higher than the average price of generic opioids.  In order to gain the $4,568 to $4,645 in benefits per opioid patient, additional market expenditures for opioids are necessary.

                  Based on the prices of opioids as reported by Consumer Reports two estimates for the additional costs for abuse-deterrent opioids are calculated.[27]  A lower-end estimate of the abuse-deterrent cost premium is calculated by taking the difference between the average cost of patented opioids currently on the market and the average cost of generic opioids currently on the market.  A higher-end estimate of the abuse-deterrent cost premium is calculated by taking the difference between the most expensive patented opioid currently on the market and the lowest price generic opioid on the market.

The average cost and most expensive cost for a one-month supply for patented opioids on the market as of July 2012 was $373 and $692, respectively.  The average cost and least expensive cost for a one-month supply of generic opioids on the market as of July 2012 was $233 and $48, respectively.  The price gap between the average patented cost and the average generic cost was $140.  The price gap between the most expensive patented cost and the least expensive generic cost was $644.  These price gaps provide a sense of the additional cost of abuse-deterrent opioids per month.

                  In 2013, there were a total of 207 million opioid prescriptions filled.[28]  Additionally, according to Express Scripts, “Short-term opioid users far outnumber longer-term opioid users.  Approximately 15% of the population filled at least one opioid prescription in any given year during the past five years; only about one in five of those patients continued to use opiate pain medications beyond 30 days.  When we apply our data to the 2013 US Census, we estimate that more than 9.4 million insured Americans were longer-term users of opioids.”[29] 

Applying the estimate that 15 percent of the population that filled at least one opioid prescription to the U.S. Census’ estimated population in 2013 of 316.1 million indicates that in 2013 47.4 million people filled an opioid prescription.[30]  This figures indicate that, on average, there were a bit more than 4 opioid prescriptions filled (4.37) per person prescribed an opioid medication in 2013.

                  Since about 80 percent of prescriptions were for less than 1-month according to Express Scripts, a conservative assumption that each prescription was written for a one month supply is made.  Based on these assumptions, the estimates imply that the total additional cost for the average abuse-deterrent opioid prescription would be between $612 (based on the average price gap) and $2,811 (based on the highest patented price to lowest generic price gap).  These additional costs reduce the total benefits from abuse-deterrent opioids calculated in Table 1 and, when subtracted from the total benefits, provide an estimated net economic benefit from abuse-deterrent opioids.  As Table 2 illustrates, depending upon the price assumption, and the opioid patient’s insurance status, the positive net benefit from abuse-deterrent opioids ranges from $1,757 per patient to $4,033 per patient.

Table 2

Total Annual Net Benefits per Patient from Abuse-deterrent Opioids

 

Average Price

 

Net Benefit per Opioid Patient

Net Benefit Commercially-insured Population

$4,032.75

Net Benefit Medicaid/uninsured Population

$3,956.42

 

 

Largest Gap

 

Net Benefit per Opioid Patient

Net Benefit Commercially-insured Population

$1,833.51

Net Benefit Medicaid/uninsured Population

$1,757.18

 

Conclusion

Pain is a costly affliction estimated to impose $635 billion in costs on people in the U.S.  Opioids are an important tool that helps people suffering from chronic pain.  However, the abuse and diversion of opioid medications has created a separate problem.  In 2007, these costs have been estimated to be as high as $55.7 billion (in 2009 dollars).  An emerging technology, abuse-deterrent opioid analgesics, has the potential to reduce the costs from opioid abuse while still providing pain patients with the medication they need. 

This issue brief reviewed the current available literature on the costs and benefits of abuse-deterrent opioids to estimate whether the net benefit from prescribing abuse-deterrent opioids is positive.  Based on the studies that have reviewed the potential benefits of current abuse-deterrent opioids compared to an estimate of the additional drug costs, abuse-deterrent opioids are associated with a positive net economic benefit. 

Specifically, the current evidence shows that abuse-deterrent opioids will reduce the costs of opioid abuse per opioid patient by $4,568 to $4,645, depending upon the patient’s insurance status.  Accounting for the estimated additional cost of abuse-deterrent opioids (between $612 and $2,811), these medicines are associated with a net economic benefit between $1,757 and $4,033.

While further research is still necessary due to the novelty of these products, the positive per opioid patient net economic benefit is an indication that abuse-deterrent opioids are an important advancement in the reduction of abuse associated with opioid pain medicines.



[1] (2011) “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” Institute of Medicine of the National Academies, June; www.iom.edu/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf.

[2] Ibid.

[3] Gaskin, Darrell J. and Richard, Patrick (2012) “The Economic Costs of Pain in the United States” Journal of Pain Vol. 13 No. 8 August; www.ncbi.nlm.nih.gov/pubmed/22607834.

[4] (2011) Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Washington (DC): National Academies Press (US); www.ncbi.nlm.nih.gov/books/NBK92516/.

[5] Brownlee, Shannon, Joannie M. Schrof, Beth Brophy, and Mary Brophy Marcus (1997) “The Quality of Mercy: Effective pain treatments already exist. Why aren’t doctors using them?” U.S. News and World Report, 3/17, p. 54-57, 60, 62, 65, 67, www.doctordeluca.com/Library/Pain/QualityOfMercy97.htm; Rasor, Joseph and Gerald Harris (2007) “Using Opioids for Patients With Moderate to Severe Pain.” J Am Osteopath Assoc. 2007; 107(suppl 5):ES4-ES10; (2009) “A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform.” Mayday Fund November 4, www.maydaypainreport.org/

Brownlee et al. reported that one quarter of all sick days taken yearly were due to chronic pain. Rasor and Harris estimated that chronic pain is the second-leading cause of absenteeism from work, following the common cold.  The Mayday Fund estimated that pain causes more than 50 million lost workdays each year.

[6] Stewart, Walter F., Ricci, Judith A., Chee E, Morganstein D, Lipton R. (2003) “Lost productive time and cost due to common pain conditions in the US workforce” JAMA 2003; 290(18): 2443-2454; www.ncbi.nlm.nih.gov/pubmed/14612481.

[7] (2013) “The Global Market for Pain Management Drugs and Devices” bcc Research, January; www.bccresearch.com/market-research/healthcare/pain-management-drugs-devices-hlc026d.html.

[8] Boyles, Salynn (2009) “Americans Spend $34 Billion on Alternative Medicine.” WebMD; www.medscape.com/viewarticle/706996.

[9] See, for instance, (2014) “Opioid Painkiller Prescribing: Where You Live Makes a Difference” Centers for Disease Control, July; www.cdc.gov/vitalsigns/opioid-prescribing/index.html; (2011) “Prescription Painkiller Overdoses in the US” Centers for Disease Control, November, www.cdc.gov/vitalsigns/PainkillerOverdoses/index.html.

[10] White AG, Birnbaum HG, Mareva MN, Daher M, Vallow S, Schein J, Katz N.J (2005) “Direct costs of opioid abuse in an insured population in the United States” Manag Care Pharm Jul-Aug;11(6):469-79; www.ncbi.nlm.nih.gov/pubmed/15998164.

[11] Birnbaum, Howard G., White, Alan G., Schiller, M., Waldman, T., Cleveland, JM, Roland, CL (2011) “Societal costs of prescription opioid abuse, dependence, and misuse in the United States” Pain Med 2011 Apr;12(4):657-67; www.ncbi.nlm.nih.gov/pubmed/21392250

[12] Strassels, Scott A. (2009) “Economic Burden of Prescription Opioid Misuse and Abuse” J Manag Care Pharm 2009; 15(7):556-62; www.asam.org/docs/advocacy/jmcpecoburdofopioidabuse.pdf?sfvrsn=0.

[13] Ibid.

[14] Strassels, Scott A. (2009) “Economic Burden of Prescription Opioid Misuse and Abuse” J Manag Care Pharm 2009; 15(7):556-62; www.asam.org/docs/advocacy/jmcpecoburdofopioidabuse.pdf?sfvrsn=0.

[15] “Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities” The Behavioral Health Coordinating Committee Prescription Drug Abuse Subcommittee U.S. Department of Health and Human Services.

[16] Moorman-Li, Robin, Carol A. Motycka, Lisa D. Inge, Jocelyn Myrand Congdon, Susan Hobson, and Brian Pokropski, (2012)” A Review of Abuse-Deterrent Opioids For Chronic Nonmalignant Pain” P&T July Vol. 37 No. 7.  To substantiate the claim the authors cited: National Institute on Drug Abuse (NIDA) (2005) “NIDA Community Drug Alert Bulletin: Prescription Drugs” U.S. Department of Health and Human Services, NIH Pub. No. 05-0580; archives.drugabuse.gov/prescripalert/; Passik SD, Kirsh KL, Donaghy KB, Portenoy RK (2006) “Pain and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse” Clin J Pain 22(2):173–181.7.

[17] (2013) “Guidance for Industry Abuse-Deterrent Opioids — Evaluation and Labeling” FDA Draft Guidance, January; www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm334743.pdf; Strassels, Scott A. (2009) “Economic Burden of Prescription Opioid Misuse and Abuse” J Manag Care Pharm 2009; 15(7):556-62; www.asam.org/docs/advocacy/jmcpecoburdofopioidabuse.pdf?sfvrsn=0; Hahn, Kathryn L. (2011) “Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs” Am Health Drug Benefits, 4(2):107-114.

[18] Hahn, Kathryn L. (2011) “Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs” Am Health Drug Benefits, 4(2):107-114.

[19] Rossiter, Louis F., Kirson, Noam Y., Shei, Amie, White, Alan G., Birnbaum, Howard G., Ben-Joseph, Rami, Michna, Edward (2014) “Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US” Journal of Medical Economics Vol. 17, No. 4, 2014, 279–287.

[20] Ibid.

[21] Ibid.  Rossiter et al. found that the impact on Medicare eligible patients was not statistically significant, which they attribute to the fact that the opioid abuse problem is significantly lower in the Medicare-eligible population.

[22] Rossiter, Louis F., Kirson, Noam Y., Shei, Amie, White, Alan G., Birnbaum, Howard G., Ben-Joseph, Rami, Michna, Edward (2014) “Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US” Journal of Medical Economics Vol. 17, No. 4, 2014, 279–287.

[23] Kirson, Noam Y, Shei, Amie, White, Alan G., Birnbaum, Howard G., Ben-Joseph, Rami, Rossiter, Louis F., Michna, Edward (2014) “Societal Economic Benefits Associated with an Extended-Release Opioid with Abuse-Deterrent Technology in the United States” Pain Medicine; 15: 1450–1454.

[24] Ibid.

[25] For instance, the price for an opioid prescription depends upon many factors such as the prescription dosage and whether the prescription is written for a patented drug or a generic drug.  Consequently, it is difficult to determine an average current price for opioid medication.  Additionally, the future price of abuse-deterrent opioids that are currently in development is, by definition, unknown.  These realities limit the precision of a cost-benefit analysis for abuse-deterrent opioids.

[26] Rossiter et al. (2014) assume that the uninsured population’s expenses and responses are similar to the Medicaid population’s results.

[27] “Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost” www.consumerreports.org/health/resources/pdf/best-buy-drugs/Opioids-2pager-FINAL-June2008.pdf.  According to the report, “Prices are based on nationwide retail average prices for July 2012. Consumer Reports Best Buy Drugs obtained prices from data provided by Source Healthcare Analytics, Inc., which is not involved in our analysis or recommendations.”

[28] Volkow, Nora D. (2014) “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse” May 14; presented to Senate Caucus on International Narcotics Control; www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse.

[29] (2014) “A Nation in Pain: Focusing on U.S. Opioid Trends for Treatment of Short-term and Longer-term Pain” Express Scripts, December.

[30] Population estimate is from the U.S. Census, www.census.gov

One Response to Estimating the Net Economic Benefit of Abuse-Deterrent Opioids

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