Estimating the Economic Cost of the Fentanyl Shock: A Cost-of-Illness Analysis of Opioid Overdose in West Virginia and Pennsylvania

After fentanyl displaced prescription opioids as the primary driver of overdose fatalities, the U.S. opioid crisis entered the so-called "fourth wave." However, most existing state-level illness cost estimates remain anchored to circa 2017. This study extends these estimates to 2022 and 2023 using the illness-cost framework developed by Florence et al. To our knowledge, this study is the first to place Pennsylvania and West Virginia within the same framework. This study uses the human capital approach to calculate two types of costs, fatal overdose and non-fatal opioid use disorder, drawing on data from the CDC WONDER mortality database, the SAMHSA NSDUH prevalence surveys, and the official annual VSL/VSLY estimates released by HHS. The results indicate that the total economic burden in both states rose by approximately 133% between 2017 and 2023, far outpacing the increase in overdose fatalities; this growth is primarily driven by a substantial expansion in OUD prevalence cases. The composition of the burden has also shifted from being dominated by fatal costs toward a larger share of nonfatal costs. West Virginia's criminal justice costs could only be estimated using scenario analysis, due to the lack of publicly released annual arrest data, reflecting a gap in public health data infrastructure between the two states.