Benefits of a Remote Monitoring Drug Program for Patients With OUD

Research presented at AMCP Nexus 2023 focused on assessing the potential economic implications of implementing remote medication monitoring (RMM) in patients with opioid use disorder who are being treated with methadone. Opioid use disorder is a serious public health concern, with a significant proportion of patients not receiving adequate doses of methadone, leading to persistent cravings, withdrawal symptoms, and high treatment dropout rates. RMM is proposed as a solution to address these issues and improve treatment outcomes.

The researchers conducted a one-year decision analytic and budget impact analysis from the perspective of healthcare payers. They aimed to evaluate the impact of implementing a clinical pathway that incorporates RMM in comparison to the standard treatment as usual (TAU) for methadone-treated patients in a population of one million individuals. Key parameters used in the analysis included the cost of RMM, the expected improvement in treatment retention with RMM, and the healthcare costs and health utility impact for retained and non-retained patients.

In the base case scenario, the cost of RMM was set at $5,000 per patient per year, with a presumed 15% improvement in treatment retention compared to TAU. The retention rate for TAU was reported to be 57% in the first 6 months and 67% in the subsequent 6 months. Health care costs for retained patients were $7,774, and their health utility was 0.574, while non-retained patients had higher costs of $22,438 and a higher health utility of 0.809. Sensitivity analyses were conducted by varying these inputs by ±10%.

The results of the economic analysis showed that over the course of one year, 613 patients per million population could be treated with RMM. The base case scenario revealed a quality-adjusted life year (QALY) gain of 0.042 and cost reductions of $250 per patient, resulting in a negative cost per QALY of -$5,936. Additionally, it was found that per member per month (PMPM) savings increased by approximately $0.026 for every 10% increase in RMM-treated patients, ranging from -$0.1 to $0.07 in various scenarios based on the cost of RMM.

Sensitivity analyses demonstrated that the cost of non-retained patients had the most significant impact on the cost per QALY changes, followed by the efficacy improvement of RMM over TAU and the 6-month utility impact in retained patients.

In conclusion, the economic evaluation indicated that the modeled base case RMM clinical pathway was economically dominant, meaning it was both more efficacious and less costly than the TAU approach. Furthermore, it exhibited a low PMPM impact even in scenarios with higher RMM costs. These findings suggest that RMM has the potential to improve the quality of life for patients with opioid use disorder while simultaneously reducing the costs associated with low treatment retention, particularly in populations where untreated patients incur high healthcare costs. The study suggests the need for additional economic evaluations as more clinical data become available.