Cost per Opioid-Free Year: A Systematic Review and Summary Analysis

Objectives Opioids remain a leading cause of death in the United States, and time free from opioid use is a common measure of effectiveness in economic evaluations of opioid use disorder (OUD) interventions. This study reviews the economic evaluation literature on OUD, identifies studies that calculated incremental cost-effectiveness ratios (ICER) based on time free from opioids, and establishes a benchmark for comparison in future research. Methods The review examined economic evaluations of OUD interventions published in the peer-reviewed literature from inception to September 2024. ICERs of cost per period of opioid-free time were extracted or calculated from studies meeting the inclusion criteria. Monetary values were converted to 2024 USD and ICERs normalized to cost per opioid-free year (OfY). Articles were classified by intervention location (United States vs international) and economic perspective. Results Fourteen articles met the inclusion criteria: 8 from the United States, 4 from Australia, 1 from Malaysia, and 1 from the United Kingdom. Among the US-based studies, the average ICER per OfY for the healthcare-sector, the state policymaker, and the societal perspective were $243 053/OfY, $17 674/OfY, and $32 125/OfY, respectively. For international studies, average ICERs for the healthcare-sector and societal perspectives were $79 765/OfY and $195 980/OfY, respectively. Conclusions Cost per OfY is a widely used metric in economic evaluations because of its relative importance as a measure of clinical effectiveness. However, a universally accepted benchmark for decision making does not yet exist. This review aggregates data from existing studies that provided this measure, offering an initial step for establishing a cost-effectiveness threshold for cost per OfY.