PRINCIPAL INVESTIGATOR: SCHACKMAN, BRUCE R
GRANT NUMBER: R01 DA033424-02S1
ABSTRACT: 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 costeffectiveness 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 comorbidities. In contrast, a definition that includes social welfare benefits of opioid dependence treatment and integrates patient experience of comorbidities and polysubstance use may be more relevant and acceptable to treatment providers and policy makers. We propose to expand our measurement of the impact of physical and mental health comorbidities and polysubstance use on quality of life in opioid dependence, consistent with the specific aims and building on the secondary data analysis and survey results of the parent study “Quality of Life Outcomes in Prescription and Injection Opioid Dependence” (R01 DA033424). Our specific aims are 1) to identify and develop descriptions of comorbidities and non-opioid substance use in opioid dependence using secondary data from the parent study, empiric data from individuals experienced with the states, expert opinion, the literature (for health states without opioid dependence), and existing health state descriptions of opioid dependence from the parent study, and 2) to compare “off the shelf” quality of life weights for opioid dependence alone, comorbidities and non-opioid substance use alone, and combined health states with opioid dependence by conducting a second wave of a web-based survey of a representative panel of US residents to assign quality of life weights to new health states with and without opioid dependence. This research is highly innovative and significant because it fills a critical gap in knowledge about quality of life in prescription and injection opioid dependence necessary to assess economic and patient-reported outcomes when substance use interventions are implemented in diverse populations experiencing comorbidities and polysubstance use. In addition, we will contribute to methodology development for combining comorbid quality of life weights.