Cost per opioid-free year: defining an emerging benchmark in addiction health economics

A comprehensive systematic review and meta-analysis published in Value in Health (October 2025) by Oyemakinde et al. provides the first aggregated synthesis of cost per opioid-free year (OfY) as an alternative to quality-adjusted life years (QALY) in evaluating opioid use disorder (OUD) interventions. This metric—reflecting the time individuals remain opioid-free—offers a clinically meaningful complement to QALYs in assessing treatment value and guiding policy decisions amid the escalating opioid crisis.

The authors analyzed 14 studies (8 U.S.-based, 6 international) spanning methadone, buprenorphine, extended-release naltrexone (XR-NTX), and combined pharmacologic and psychosocial interventions. Studies were standardized to 2024 U.S. dollars and normalized to report incremental cost-effectiveness ratios (ICERs) per opioid-free year.

Key findings included:

• U.S. healthcare-sector perspective: average ICER $243,053 per OfY, ranging from $8,938 to $1.28 million.
• State policymaker perspective: average ICER $17,674 per OfY.
• Societal perspective: average ICER $32,125 per OfY, with values typically lower due to inclusion of non-medical benefits such as reduced crime and improved productivity.
• International studies: average ICERs $79,765 (healthcare) and $195,980 (societal) per OfY, reflecting structural and cost differences in healthcare systems.

Treatments integrating extended-release naltrexone before prison release and community-based methadone programs demonstrated the lowest ICERs, suggesting favorable cost-effectiveness within criminal-justice and high-risk populations. Conversely, traditional methadone detoxification and office-based buprenorphine models yielded higher ICERs, often driven by operational costs and limited retention rates.

The review underscores substantial variability in cost-effectiveness driven by geographic context, intervention design, and economic perspective. Importantly, the absence of a universal willingness-to-pay (WTP) threshold for opioid-free time limits comparability across studies. The authors propose using OfY as a complementary metric to QALY, particularly in addiction medicine, where sustained abstinence itself holds clinical and social value.

This work lays the foundation for future benchmark development—potentially enabling policymakers to define cost-effectiveness thresholds specific to OUD interventions. The findings also advocate for standardized economic reporting and inclusion of OfY outcomes in future clinical trials and pharmacoeconomic evaluations.

#OpioidCrisis #HealthEconomics #CostEffectiveness #AddictionMedicine #PublicHealthPolicy

Editorial Note

This text was organized with the support of artificial intelligence, but it was critically reviewed and validated by a qualified professional to ensure scientific accuracy and reliability.