Economic Evaluation of Mindfulness-Oriented Recovery Enhancement for the Treatment of Opioid Misuse

OBJECTIVE: Opioid misuse exacts a tremendous toll on society. Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious treatment for opioid misuse. Yet, the cost-effectiveness of this intervention remains unknown. METHODS: Cost-effectiveness analyses of a randomized clinical trial with enrollment of 250 adults with chronic pain prescribed long-term opioid therapy who were misusing opioids. Participants were randomized to MORE (training in mindfulness, reappraisal, and savoring positive experiences) or supportive group psychotherapy across 8 weekly 2-hour groups. Incremental cost-effectiveness ratios were computed using the primary outcome of opioid misuse at 9-month follow-up, as assessed by a composite measure based on self-report, clinical interview, and urine screen. RESULTS: A total of 250 randomized patients (64.0% female) had an average age of 51.8 years (SD = 11.9), were mostly taking oxycodone or hydrocodone (69%), and had mean morphine equivalent opioid dose of 101.0 (IQR = 74) mg. At the 9-month follow-up, the difference in the probability of having a positive drug misuse index rating was 0.24 (0.54 for MORE participants vs 0.78 for controls). The incremental cost-effectiveness ratios of MORE relative to supportive psychotherapy was $116.3 per averted case of opioid misuse. CONCLUSIONS: Given MORE's cost-effectiveness and a benefit-to-cost of 12:1, private and public payers should consider disseminating this evidence-based therapy broadly across the nation to reduce mortality and morbidity associated with the ongoing opioid crisis.