Economic Evaluation of Mindfulness-Oriented Recovery Enhancement for the Treatment of Opioid Misuse

OBJECTIVEOpioid misuse exacts a tremendous toll on society. Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious treatment for opioid misuse. Yet, the cost-effectiveness of this intervention remains unknown. METHODSCost-effectiveness and cost-benefit analyses of a randomized clinical trial with enrollment of 250 adults with chronic pain prescribed long-term opioid therapy who were misusing opioids. Participants were randomized to MORE (training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy across 8 weekly 2-hour groups. Incremental cost-effectiveness ratios (ICER) and benefit-to-cost ratios (BCRs) were computed using the primary outcome of opioid misuse at 9-month follow-up, as assessed by a composite measure based on self-report, clinical interview, and urine screen. RESULTS250 randomized patients (64.0% female) had an average age of 51.8 years (SD=11.9), were mostly taking oxycodone or hydrocodone (69%), and had mean morphine equivalent opioid dose of 101.0 (IQR=74) mg. At 9-mo. follow-up, the difference in the probability of having a positive Drug Misuse Index (DMI) rating was 0.24 (0.54 for MORE participants vs. 0.78 for controls). The ICER of MORE relative to supportive psychotherapy was $116.3 per averted case of opioid misuse, $8.9 per life-year, and $8.0 per quality-adjusted life-year. MORE is cost-saving vs. supportive psychotherapy after adjusting for healthcare costs. Excluding all benefits associated with averting fatal overdoses results in a BCR of 84.2. CONCLUSIONSGiven MOREs cost-effectiveness, private and public payers should consider disseminating this evidence-based therapy broadly across the nation to reduce mortality and morbidity associated with the ongoing opioid crisis. HIGHLIGHTSO_LIMindfulness-Oriented Recovery Enhancement (MORE) substantially reduced opioid misuse among adults with chronic pain on long-term opioid therapy. C_LIO_LIMORE was highly cost-effective vs. supportive psychotherapy, costing $116 per averted opioid misuse case, and MORE was cost saving when accounting for healthcare costs associated with opioid misuse. C_LIO_LIFindings suggest wide dissemination of this evidence-based treatment could yield major healthcare and other economic benefits in addressing the opioid crisis. C_LI