Quality of life is increasingly important as a measure of chronic disease treatment outcomes. Despite growing recognition that substance abuse is a chronic disease, and the increasingly recognized negative effects on quality of life caused by the growth of nonmedical prescription drug use, quality of life is rarely measured in substance abuse treatment studies. Opioid dependence treatment is usually evaluated based on measures of abstinence. Related economic research has frequently used a cost-benefit approach that emphasizes economic offsets to treatment costs found outside of health care, such as in the legal system. There is a critical need for quality of life data in opioid dependence because of the availability of new pharmaceutical treatments (buprenorphine-naloxone and injection naltrexone). Quality of life weights are required to compare the cost- effectiveness of the new treatments to other types of care covered by private and public health insurance. This approach recognizes that the value of treatment should be appropriate to the additional cost to the health system, but need not be cost saving when compared to other medical interventions. Economic theory and standard practice require quality of life measures for cost-effectiveness analysis to take the perspective of the community, only consider physical and mental symptoms, and value opioid dependence separately from co- morbidities. In contrast, a definition that includes social welfare benefits of opioid dependence treatment and integrates patient experience of co morbidities may be more relevant and acceptable to treatment providers and policy makers. We propose to measure quality of life in opioid dependence using a community survey and secondary data collected from patients, compare outcomes with and without social welfare considerations, and develop """"""""off the shelf"""""""" tools for researchers that include guidance on how to account for co-morbidities.
Our specific aims are 1) to create an """"""""off the shelf"""""""" list of quality o life weights for opioid dependence health states with and without social welfare considerations by developing and conducting an internet survey to directly elicit quality of life weights from a representative sample of US residents;2) to estimate quality of life weights for patient-reported opioid dependence health states and determine the impact of social welfare considerations using data from injection and prescription opioid users enrolled in two multi-site National Drug Abuse Treatment Clinical Trials Network randomized trials, for comparison with the """"""""off the shelf"""""""" weights;and 3) to assess the impact on opioid dependence quality of life weights of poorly controlled HIV and of chronic HCV using self-reported data from HIV-infected opioid dependent patients enrolled in the multi-site BHIVES cohort, and to compare these results with published algorithms for combining """"""""off the shelf"""""""" weights for co-morbidities. This research is highly innovative and significant because it fills a critical gap in knowledge about quality of lif in prescription and injection opioid dependence necessary to assess economic and patient-reported outcomes, and addresses the interface between health system and social welfare perspectives.

Public Health Relevance

Dependence on and addiction to opioid drugs such as heroin, oxycontin, and hydrocodone (Vicodin) places an enormous burden on the quality of life of patients and their families, and is a growing problem due to increases in opioid prescription drug misuse. In this study, we will measure the quality of life impact of opioid dependence from the point of view of members of the community through an internet survey and using data collected from opioid users in previous studies. Our results will help researchers and health care decision makers evaluate the cost-effectiveness of new treatments for opioid dependence in the same way that they consider evidence about the cost-effectiveness of other medical treatments.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
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Duffy, Sarah Q
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Weill Medical College of Cornell University
Public Health & Prev Medicine
Schools of Medicine
New York
United States
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Wittenberg, Eve; Bray, Jeremy W; Gebremariam, Achamyeleh et al. (2017) Joint Utility Estimators in Substance Use Disorders. Value Health 20:458-465
Bray, Jeremy W; Aden, Brandon; Eggman, Ashley A et al. (2017) Quality of life as an outcome of opioid use disorder treatment: A systematic review. J Subst Abuse Treat 76:88-93
Krebs, Emanuel; Kerr, Thomas; Wood, Evan et al. (2016) Characterizing Long-Term Health Related Quality of Life Trajectories of Individuals With Opioid Use Disorder. J Subst Abuse Treat 67:30-7
Wittenberg, Eve; Bray, Jeremy W; Aden, Brandon et al. (2016) Measuring benefits of opioid misuse treatment for economic evaluation: health-related quality of life of opioid-dependent individuals and their spouses as assessed by a sample of the US population. Addiction 111:675-84
Nosyk, Bohdan; Min, Jeong E; Evans, Elizabeth et al. (2015) The Effects of Opioid Substitution Treatment and Highly Active Antiretroviral Therapy on the Cause-Specific Risk of Mortality Among HIV-Positive People Who Inject Drugs. Clin Infect Dis 61:1157-65
Nosyk, B; Bray, J W; Wittenberg, E et al. (2015) Short term health-related quality of life improvement during opioid agonist treatment. Drug Alcohol Depend 157:121-8
Aden, Brandon; Dunning, Allison; Nosyk, Bohdan et al. (2015) Impact of Illicit Drug Use on Health-Related Quality of Life in Opioid-Dependent Patients Undergoing HIV Treatment. J Acquir Immune Defic Syndr 70:304-10
Aden, Brandon; Nosyk, Bohdan; Wittenberg, Eve et al. (2014) Health-Related Quality of Life in HIV-Infected and At-Risk Women: The Impact of Illicit Drug Use and Hepatitis C on a Community Preference Weighted Measure. Med Decis Making 34:800-8