The cost of opioid use disorder and the value of aversion

Background: The objective of this study was twofold. First, to update and estimate the economic burden of opioid use disorder (OUD) to the U.S. from the perspectives of the healthcare sector, taxpayer, and society, overall and by age. Second, to estimate the mean present value of averting an OUD, overall and by age, for use in economic evaluations of prevention-focused interventions. Methods: This was a retrospective secondary analysis using 2018 data from the National Survey on Drug Use and Health, and the CDC WONDER Database on all U.S. persons, at least 12 years old, with an OUD, or who died of opioid overdose. Total OUD-related costs were estimated according to age and stakeholder perspective. Mean costs weighted by insurance type and the probability of mortality were estimated for each age, then used to estimate the mean present value of OUD aversion according to age and stakeholder perspective. Results: The total annual OUD-related costs to the U.S. in 2018 were $786.8 billion to society, $93 billion to taxpayers, and $89.1 billion to the healthcare sector. The mean present value of averting an OUD, across all ages, was $2.2 million, $325,125, and $244,030 from the societal, taxpayer, and healthcare sector perspectives, respectively. Conclusions and relevance: The age-specific values of averting an OUD allow for more robust and targeted economic evaluations of competing interventions to reduce the burden of opioids on multiple stakeholders. The rise in the annual OUD-related cost largely reflects the increase in overdose deaths attributable to synthetic opioids (e.g., fentanyl).Y