PMH45 - MODELLING THE BUDGETARY IMPACT OF TREATING OPIOID ADDICTION IN THE ENGLISH MUNICIPAL SETTING

Abstract

Our model estimated budgetary impacts in terms of direct treatment costs and other services provided by local communities, including criminal justice, welfare, child safeguarding and healthcare. We modelled a large town in England across a one-year timeframe. Patients were assumed to receive opioid agonist treatment (OAT) and psychosocial support. Direct OAT costs (medicine acquisition, dispensing and supervised consumption) were based on published sources. Non-pharmacological intervention costs (e.g. counselling) were based on local expert opinion. Wider societal costs were based on published analyses of the National Treatment Outcome Research Study and published references. Expert opinion informed child safeguarding estimates. Two main clinical parameters drove costs: i. retention in treatment and ii. Proportion of urine samples which are free from illicit opioids (i.e. no ‘use on top’), these came from published trial data. 875 patients (50% of local opioid users) received OAT, 60% methadone and 40% buprenorphine. Treatment costs were £821,305. Indirect healthcare costs were £2.34m (£1.6m in users not seeking treatment). Crime costs were £13.4m (£9.1m for users not in treatment). The cost of children in care following parents dropping out of OAT, or not entering OAT at all, was £7.1m although this estimate was based on conservative assumptions. Potential additional cost of child safeguarding was explored in sensitivity analysis. Total cost associated with opioid-using population was £28.9m. If an additional 10% of patients were treated, this annual cost would be reduced by £1.7m. Our model shows that treating opioid addiction with OAT delivers a net cost saving to communities. New treatment approaches should address the issues that prevent users from seeking OAT. The model has potential to be adapted to local settings using locally-gathered evidence.