Cost-Effectiveness Comparison of Opoid Substitution Therapy Vs. Non-Pharmcologic Therapy In The State of Kuwait

• Published in: Value in health 2017-10, Vol.20 (9), p.A711
• Main Authors: Hren, Rzzz, Milanic, M
• Format: Article
• Language: English
• Subjects: Buprenorphine; Combination therapy; Cost analysis; Dominance; Health care expenditures; Jurisdiction; Medical treatment; Naloxone; Narcotics; Opioids; Pharmacology; Quality adjusted life years; Robustness; Sensitivity analysis; Simulation; Willingness to pay
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.1878

OBJECTIVES: The primary goal of our study was to compare comprehensively cost-effectiveness of treatment option for pharmacologic opioid substitution therapy with buprenorphine/naloxone combination and non-pharmacologic treatment in the State of Kuwait (SoK). METHODS: We have adapted two different micro-simulation decision models to the real-life conditions in SoK using locally specific data for treatment costs of buprenorphine/naloxone combination. In the first model, we took into account the protocol that is applied in SoK for pharmacologic treatment arm and non-pharmacologic treatment arm. In the second alternative model, costs in the pharmacologic treatment arm and non-pharmacologic treatment arm were fully based on the UK data and then adjusted to conditions of the local jurisdiction. RESULTS: Using the first model, we have demonstrated that comparison of pharmacologic treatment arm with non-pharmacologic treatment arm resulted in incremental cost-effectiveness ratio (ICER) of 13,307 KWD/QALY which was below conservative willingness-to-pay threshold of 15,221 KWD/QALY (50,000 USD/QALY) and way below updated value of 30,442 KWD/QALY (100,000 USD/QALY): the pharmacologic treatment was thus deemed highly cost-effective when compared to non-pharmacologic treatment arm. When including only direct costs in the first model, the resulting ICER was 22,826 KWD/QALY, i.e., below the updated willingness-to-pay threshold of 30,442 KWD/QALY (100,000 USD/QALY): even under such stringent conditions, the pharmacologic treatment arm was therefore cost effective when compared to non-pharmacologic treatment arm. In the second alternative model, we have shown that under base case scenario pharmacologic treatment arm dominated non-pharmacologic treatment arm by saving 1,670 KWD and gaining 0.1534 QALY per patient per year. The dominance was retained even when only direct costs were considered. Both deterministic and probabilistic sensitivity analysis confirmed robustness of our findings. CONCLUSIONS: Results of our study indicated that in SoK, the pharmacologic opioid substitution therapy using buprenorphine/naloxone combination when compared to non-pharmacologic therapy was at least highly cost-effective if not cost saving.