Background:Only 1 in 5 of the nearly 2.4 million Americans with an opioid use disorder received treatment in 2015. Fewer than half of Californians who received treatment in 2014 received opioid agonist treatment (OAT), and regulations for admission to OAT in California are more stringent than federal regulations.

Objective:To determine the cost-effectiveness of OAT for all treatment recipients compared with the observed standard of care for patients presenting with opioid use disorder to California’s publicly funded treatment facilities.

Design:Model-based cost-effectiveness analysis.

Data Sources:Linked population-level administrative databases capturing treatment and criminal justice records for California (2006 to 2010); published literature.

Target Population:Persons initially presenting for publicly funded treatment of opioid use disorder.

Time Horizon:Lifetime.


Intervention:Immediate access to OAT with methadone for all treatment recipients compared with the observed standard of care (54.3% initiate opioid use disorder treatment with medically managed withdrawal).

Outcome Measures:Discounted quality-adjusted life-years (QALYs) and discounted costs.

Results of Base-Case Analysis:Immediate access to OAT for all treatment recipients costs less (by $78 257), with patients accumulating more QALYs (by 0.42) than with the observed standard of care. In a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, total lifetime savings for this cohort could be as high as $3.8 billion.

Results of Sensitivity Analysis:99.6% of the 2000 simulations resulted in lower costs and more QALYs.

Limitation:Nonrandomized delivery of OAT or medically managed withdrawal.

Conclusion:The value of publicly funded treatment of opioid use disorder in California is maximized when OAT is delivered to all patients presenting for treatment, providing greater health benefits and cost savings than the observed standard of care.


I’m a HUGE fan of primary care provided addiction treatment, especially for opiate abuse since we have such an effective treatment in buprenorphine.  These folks generally have so many other medical problems best addressed by a primary care provider–things that were ignored in their active addiction, things that can be caught early and turned around to prevent greater problems down the road.  It’s been said that “teeth and taxes are a 3rd year of recovery problem”, I’ve even heard that “divorce is one of the 5-year promises”.  There’s a certain amount of truth in these statements; typically at about the third year in good recovery, dental problems and prior tax neglect are finally addressed.  If one member of the relationship is recovering while the other is still active, by about 5 years the couple has grown apart to the point that a solid relationship is unlikely.

Dr. Raymond Oenbrink
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