Economic Evaluations of Pharmacologic Treatment for Opioid Use Disorder: A Systematic Literature Review

Erica N. Onuoha, Jared A. Leff, Bruce R. Schackman, Kathryn E. McCollister, Daniel Polsky, Sean M. Murphy

Research output: Contribution to journalArticlepeer-review


Objective: The crisis of opioid use puts a strain on resources in the United States and worldwide. There are 3 US Food and Drug Administration–approved medications for treatment of opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone (XR-NTX). The comparative effectiveness and cost vary considerably among these 3 medications. Economic evaluations provide evidence that help stakeholders efficiently allocate scarce resources. Our objective was to summarize recent health economic evidence of pharmacologic treatment of opioid use disorder interventions. Methods: We searched PubMed for peer-reviewed studies in English from August 2015 through December 2019 as an update to a 2015 review. We used the Drummond checklist to evaluate and categorize economic evaluation study quality. We summarized results by economic evaluation methodology and pharmacologic treatment modality. Results: We identified 105 articles as potentially relevant and included 21 (4 cost-offset studies and 17 cost-effectiveness/cost-benefit studies). We found strengthened evidence on buprenorphine and methadone, indicating that these treatments are economically advantageous compared with no pharmacotherapy, but found limited evidence on XR-NTX. Only half of the cost-effectiveness studies used a generic preference-based measure of effectiveness, limiting broad comparison across diseases/disorders. The disease/disorder-specific cost-effectiveness measures vary widely, suggesting a lack of consensus on the value of substance use disorder treatment. Conclusion: We found studies that provide new evidence supporting the cost-effectiveness of buprenorphine compared with no pharmacotherapy. We found a lack of evidence supporting superior economic value for buprenorphine versus methadone, suggesting that both are attractive alternatives. Further economic research is needed on XR-NTX, as well as other emerging pharmacotherapies, treatment modalities, and dosage forms.

Original languageEnglish (US)
Pages (from-to)1068-1083
Number of pages16
JournalValue in Health
Issue number7
StatePublished - Jul 2021


  • cost offset
  • cost-benefit analysis
  • cost-effectiveness analysis
  • healthcare utilization
  • opioid use disorder
  • systematic review

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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