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Cost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse.

TitleCost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse.
Publication TypeJournal Article
Year of Publication2018
AuthorsMurphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR
JournalAnn Intern Med
Date Published2018 Dec 18
ISSN1539-3704
Abstract

Background: Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder.

Objective: To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone.

Design: Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs.

Data Sources: Study instruments.

Target Population: Adults with opioid use disorder.

Time Horizon: 24-week intervention with an additional 12 weeks of observation.

Perspective: Health care sector and societal.

Interventions: Buprenorphine-naloxone and extended-release naltrexone.

Outcome Measures: Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids.

Results of Base-Case Analysis: Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine-naloxone to be preferable to extended-release naltrexone in 97% of bootstrap replications at 24 weeks and in 85% at 36 weeks. Similar results were obtained with incremental time abstinent from opioids as an outcome and with use of the societal perspective.

Results of Sensitivity Analysis: The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation.

Limitation: Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs.

Conclusion: Buprenorphine-naloxone is preferred to extended-release naltrexone as first-line treatment when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone.

Primary Funding Source: National Institute on Drug Abuse, National Institutes of Health.

DOI10.7326/M18-0227
Alternate JournalAnn. Intern. Med.
PubMed ID30557443
PubMed Central IDPMC6581635
Grant ListU10 DA013046 / DA / NIDA NIH HHS / United States
U10 DA015831 / DA / NIDA NIH HHS / United States
U10 DA013035 / DA / NIDA NIH HHS / United States
UG1 DA013034 / DA / NIDA NIH HHS / United States
UG1 DA013720 / DA / NIDA NIH HHS / United States
HHSN271201200017C / DA / NIDA NIH HHS / United States
P30 DA040500 / DA / NIDA NIH HHS / United States
R01 DA035808 / DA / NIDA NIH HHS / United States
UG1 DA013714 / DA / NIDA NIH HHS / United States
U10 DA013714 / DA / NIDA NIH HHS / United States
UG1 DA015831 / DA / NIDA NIH HHS / United States
UG1 DA013035 / DA / NIDA NIH HHS / United States
HHSN271201500065C / DA / NIDA NIH HHS / United States
U10 DA013732 / DA / NIDA NIH HHS / United States
K24 DA022412 / DA / NIDA NIH HHS / United States
U10 DA013045 / DA / NIDA NIH HHS / United States
U10 DA013034 / DA / NIDA NIH HHS / United States
UG1 DA013732 / DA / NIDA NIH HHS / United States
U10 DA015833 / DA / NIDA NIH HHS / United States
U10 DA013720 / DA / NIDA NIH HHS / United States
Division: 
Comparative Effectiveness & Outcomes Research
Category: 
Faculty Publication