{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:49:32Z","timestamp":1791416972713,"version":"4.3.3"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["14\/224\/04"],"award-info":[{"award-number":["14\/224\/04"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Long\u2010term strong opioid use for chronic non\u2010malignant pain (CNMP) represents a significant public health challenge, associated with reduced health\u2010related quality of life (HRQoL) and increased mortality. The Improving the Wellbeing of people with Opioid Treated CHronic pain (I\u2010WOTCH) trial demonstrated that a multicomponent intervention supporting opioid withdrawal in people with CNMP successfully reduced opioid consumption compared with best usual care (BUC), without adversely affecting perceived pain levels. This study aimed to assess the value\u2010for\u2010money of the strategies tested in the I\u2010WOTCH trial, from the perspective of the United Kingdom National Health Service (NHS) and Personal and Social Services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>Within\u2010trial cost\u2010consequence (CCA) and model\u2010based cost\u2010effectiveness analyses (CEA), over one year and lifetime horizons, respectively. Data were sourced from the I\u2010WOTCH trial, which recruited 608 participants from 191 primary care centres in England between May 2017 and January 2019 and followed them up for up to 12 months. Participants received either BUC or 3 group sessions (lasting one day each) led by a trained intervention nurse and by a lay person with CNMP and lived experience with opioid tapering. These sessions, designed to develop self\u2010management skills, were supplemented by ongoing one\u2010to\u2010one support from nursing and lay personnel during follow\u2010up. We used a probabilistic state\u2010transition model to predict expected quality\u2010adjusted life years (QALYs) and costs (in UK \u00a3) of each strategy over the lifetime of an individual. Model input parameters were derived mostly from the I\u2010WOTCH trial. Opioid\u2010related excess mortality and fracture rates were extracted from the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Individual\u2010level healthcare resource use and generic HRQoL [measured using the EuroQOL five dimensions questionnaire (Equation 5D)] were collected at baseline, 4, 8 and 12\u2009months, and analysed to estimate total costs and health consequences for the I\u2010WOTCH and BUC groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>I\u2010WOTCH had higher costs and similar HRQoL outcomes compared with BUC at 12\u2009months. When accounting for long\u2010term reductions in mortality and morbidity from decreased exposure to strong opioids, our long\u2010term model predicted I\u2010WOTCH to yield higher costs and higher QALYs than BUC over the patient's lifetime, resulting in a base case incremental cost\u2010effectiveness ratio of \u00a329\u2009543\/QALY (2019 prices). Results were sensitive to structural assumptions in the model (i.e. cohort starting age, treatment effect weaning rate). Our probabilistic sensitivity analysis found I\u2010WOTCH to have a 50% probability of being cost\u2010effective compared with BUC for willingness\u2010to\u2010pay thresholds ranging between 0 and \u00a3100\u2009000\/QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Improving the Wellbeing of people with Opioid Treated CHronic pain intervention supporting opioid withdrawal in people with chronic non\u2010malignant pain appears to be cost\u2010effective on average, but further research is warranted to reduce current levels of decision uncertainty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70534","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:01:23Z","timestamp":1791414083000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing opioid use for chronic pain with a group\u2010based intervention: Economic evaluation using randomised controlled trial data"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-695X","authenticated-orcid":false,"given":"Sheeja","family":"Manchira Krishnan","sequence":"first","affiliation":[{"name":"Department of Health Sciences University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0365-2605","authenticated-orcid":false,"given":"Vijay S.","family":"Gc","sequence":"additional","affiliation":[{"name":"Centre for Health Economics University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2494-5685","authenticated-orcid":false,"given":"Tom","family":"Bromilow","sequence":"additional","affiliation":[{"name":"York Health Economics Consortium University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1866-9752","authenticated-orcid":false,"given":"Joe W. E.","family":"Moss","sequence":"additional","affiliation":[{"name":"York Health Economics Consortium University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-2566","authenticated-orcid":false,"given":"Katie","family":"Booth","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-8078","authenticated-orcid":false,"given":"Harbinder K.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8342-8421","authenticated-orcid":false,"given":"Andrea","family":"Manca","sequence":"additional","affiliation":[{"name":"Centre for Health Economics University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-0930","authenticated-orcid":false,"given":"Cynthia Paola","family":"Iglesias Urrutia","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the I\u2010WOTCH team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"WHO.Opioid overdose. 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