Journal of General Internal Medicine

, Volume 27, Issue 6, pp 669–676 | Cite as

Cost-Effectiveness of Long-Term Outpatient Buprenorphine-Naloxone Treatment for Opioid Dependence in Primary Care

  • Bruce R. Schackman
  • Jared A. Leff
  • Daniel Polsky
  • Brent A. Moore
  • David A. Fiellin
Original Research

ABSTRACT

BACKGROUND

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.

OBJECTIVE

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.

MAIN MEASURES

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.

KEY RESULTS

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.

CONCLUSIONS

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 WORDS

buprenorphine-naloxone primary health care cost-effectiveness opioid substitution therapy 

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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Bruce R. Schackman
    • 1
  • Jared A. Leff
    • 1
  • Daniel Polsky
    • 2
  • Brent A. Moore
    • 3
  • David A. Fiellin
    • 4
  1. 1.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Division of Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Department of PsychiatryYale University School of MedicineNew HavenUSA
  4. 4.Department of MedicineYale University School of MedicineNew HavenUSA

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