The Value of Shorter Initial Opioid Prescriptions: A Simulation Evaluation.

Abstract

During the period from 1999 to 2016, more than 350,000 Americans died from overdoses related to the use of prescription opioids. To the extent that supply is directly related to overprescribing, policy interventions aimed at changing prescriber behavior, such as the recent Centers for Disease Control and Prevention guideline, are clearly warranted. Although these could plausibly reduce the prevalence of opioid overuse and dependency, little is known about their economic and health-related impacts. The aim of this study was to quantify the efficacy of a policy intervention aimed at reducing the length of initial opioid prescriptions. A Markov decision process model was fitted on a retrospective cohort of 827,265 patients, and patient cost and health trajectories were simulated over a 24-month period. The model's parameters were based on patients who received short (≤ 3days) or long (> 7days) initial opioid prescriptions, matched using propensity score methods. All active-duty US Army soldiers from 2011 to 2014; the data contained detailed medical and administrative information on over 11 million soldier-months corresponding to 827,265 individual soldiers. Overall costs of a policy change, quality-adjusted life-years (QALYs) gained, and $/QALY gained. Over a 2-year horizon, a reassignment of 10,000 patients to short initial duration would generate a cost saving in the vicinity of $3.1 million (excluding program costs), and would also lead to an estimated 4451 additional opioid-free months, i.e. months without any opioid prescriptions. The analysis found that efforts to change prescriber behavior can be cost effective, and further studies into the implementation of such policies are warranted.