The Growing Financial Impact of OUD
The total economic impact of OUD, including lost wages, criminal justice costs, and health care expenses, has surpassed three-quarters of a trillion dollars. Hospitalization costs, driven by infections and other medical conditions linked to opioid misuse, are a major contributor to the $63 billion health care expenditure. For payers, finding effective ways to mitigate these costs is crucial.
A New Approach to OUD Treatment
One of the most effective treatments for OUD is XR-naltrexone, a monthly injectable that has been shown to increase abstinence and reduce overall health care costs. Despite its benefits, XR-naltrexone remains underutilized, with only about 1% of OUD patients receiving this treatment, even though studies indicate that 10 to 30% of patients prefer naltrexone-based therapies.
A significant barrier to the wider adoption of XR-naltrexone has been the lengthy initiation process. Patients must abstain from opioids for several days before starting XR-naltrexone to avoid severe withdrawal symptoms, a process that traditionally takes around two weeks. This delay often results in treatment dropout, relapse and subsequent rehospitalization, driving up costs for payers.
Accelerated Treatment Protocol Shows Promise
Recent developments in OUD treatment have led to a faster approach for initiating XR-naltrexone. This new protocol involves more aggressive management of withdrawal symptoms that combines a single day of opioid tapering with low-dose oral naltrexone and non-opioid medications. As a result, patients can begin XR-naltrexone within five to seven days, significantly reducing the time and resources required for withdrawal management.
In a randomized trial conducted across six community-based treatment programs, this rapid initiation method demonstrated a substantial improvement in treatment outcomes. Patients using the accelerated approach were significantly more likely to receive XR-naltrexone compared to those following the traditional method (62.7% vs. 35.8%). Additionally, the severity of withdrawal symptoms was comparable between the two groups.
Implications for Health care Costs and Payers
For payers, the benefits of this accelerated treatment protocol are clear. The trial revealed that patients required fewer admission days—an average of seven days compared to 14.5 days with the traditional approach—to initiate XR-naltrexone. This reduction in hospitalization time translates directly into cost savings.
While the rapid initiation protocol does require additional staff training and more intensive monitoring, resources are readily available to support its implementation. Free federally funded programs, such as the Providers Clinical Support System-Medications for Opioid Use Disorders (PCSS-MOUD) and the Opioid Response Network, offer training to help providers and treatment programs adopt this method.
A Path to Cost Savings and Better Outcomes
The accelerated initiation of XR-naltrexone represents a critical opportunity for payers to reduce the financial burden of OUD on the health care system. By facilitating faster treatment initiation, this approach can lower the risk of treatment dropout, prevent relapses, and decrease the need for prolonged hospitalizations. Broader implementation of this protocol through updated drug formularies and provider training could lead to significant cost savings and better health outcomes, making it a pivotal strategy in the fight against OUD.
For payers, embracing this innovative treatment approach offers a pathway to more efficient care and substantial cost reductions in managing OUD. To learn more, contact us at Matisyahu.Shulman@nyspi.columbia.edu or visit www.EasyMOUD.com.
Matisyahu Shulman, MD, is a board-certified general and addiction psychiatrist and a clinician-scientist. He is one of the lead authors of the Surmounting Withdrawal to Initiate Fast Treatment with Naltrexone (SWIFT) study supported by the National Institutes of Health (NIH) HEAL Initiative through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. His research is focused on opioid use disorder clinical trials and the use of technology to enhance implementation, quality improvement and treatment delivery.
Sources
The Cost of Opioid Use Disorder and the Value of Aversion