Cost-Effectiveness of Long-Term Outpatient Buprenorphine-Naloxone Treatment for Opioid Dependence in Primary Care
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Primary care physicians with appropriate training may prescribe buprenorphine-naloxone (bup/nx) to treat opioid dependence in US office-based settings, where many patients prefer to be treated. Bup/nx is off patent but not available as a generic.
We evaluated the cost-effectiveness of long-term office-based bup/nx treatment for clinically stable opioid-dependent patients compared to no treatment.
DESIGN, SUBJECTS, AND INTERVENTION
A decision analytic model simulated a hypothetical cohort of clinically stable opioid-dependent individuals who have already completed 6 months of office-based bup/nx treatment. Data were from a published cohort study that collected treatment retention, opioid use, and costs for this population, and published quality-of-life weights. Uncertainties in estimated monthly costs and quality-of-life weights were evaluated in probabilistic sensitivity analyses, and the economic value of additional research to reduce these uncertainties was also evaluated.
Bup/nx, provider, and patient costs in 2010 US dollars, quality-adjusted life years (QALYs), and incremental cost-effectiveness (CE) ratios ($/QALY); costs and QALYs are discounted at 3% annually.
In the base case, office-based bup/nx for clinically stable patients has a CE ratio of $35,100/QALY compared to no treatment after 24 months, with 64% probability of being < $100,000/QALY in probabilistic sensitivity analysis. With a 50% bup/nx price reduction the CE ratio is $23,000/QALY with 69% probability of being < $100,000/QALY. Alternative quality-of-life weights result in CE ratios of $138,000/QALY and $90,600/QALY. The value of research to reduce quality-of-life uncertainties for 24-month results is $6,400 per person eligible for treatment at the current bup/nx price and $5,100 per person with a 50% bup/nx price reduction.
Office-based bup/nx for clinically stable patients may be a cost-effective alternative to no treatment at a threshold of $100,000/QALY depending on assumptions about quality-of-life weights. Additional research about quality-of-life benefits and broader health system and societal cost savings of bup/nx therapy is needed.
KEY WORDSbuprenorphine-naloxone primary health care cost-effectiveness opioid substitution therapy
- 1.Results from the 2009 National Survey on Drug Use and Health: Volume 1. Summary of National Findings. http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm. Accessed November 10, 2011.
- 8.Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2003(2):CD002207.Google Scholar
- 9.CSAT Buprenorphine Information Center. Drug Addiction Treatment Act of 2000. http://buprenorphine.samhsa.gov/data.html. Accessed November 10, 2011.
- 11.Clark HW. The State of Buprenorphine Treatment. Paper presented at: Buprenorphine in the Treatment of Opioid Addiction: Reassessment 2010; May 10, 2010; Washington, DC.Google Scholar
- 12.Evaluation of the Buprenorphine Waiver Program: Buprenorphine Reimbursement and Availability Tracking Study. http://www.avisagroup.com/images/Final_Report_of_Tracking_Study.pdf. Accessed November 10, 2011.
- 14.Food and Drug Administration. Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations. http://www.accessdata.fda.gov/scripts/cder/ob/default.cfm. Accessed November 10, 2011.
- 15.Murray L, ed. Red book 2010 pharmacy’s fundamental reference. Montvale, NJ: Thomson PDR; 2010.Google Scholar
- 18.Anonymous. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.Treatment Improvement Protocol (TIP) Series 40. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004.Google Scholar
- 21.Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.Google Scholar
- 24.Tan-Torres Edejer T, Baltussen R, Adam T, et al., eds. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva: World Health Organization; 2003.Google Scholar
- 32.U.S. Department of Labor Bureau of Labor Statistics. National Compensation Survey. http://data.bls.gov. Accessed November 10, 2011.
- 33.State of Connecticut Department of Labor, History of minimum wage laws. http://www.ctdol.state.ct.us/wgwkstnd/wage-hour/history.htm. Accessed November 10, 2011.
- 43.Briggs A, Schulpher M, Claxton K. Decision Modelling for Health Economic Evaluation. Oxford, United Kingdom: Oxford University Press; 2006.Google Scholar
- 44.The Mental Health Parity and Addiction Equity Act. http://cciio.cms.gov/programs/protections/mhpaea/mhpaea_factsheet.html. Accessed November 10, 2011.
- 49.U.S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. http://www.cms.hhs.gov/. Accessed November 10, 2011.