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

• Published in: Journal of general internal medicine : JGIM 2012-06, Vol.27 (6), p.669-676
• Main Authors: Schackman, Bruce R., Leff, Jared A., Polsky, Daniel, Moore, Brent A., Fiellin, David A.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult and adolescent clinical studies; Biological and medical sciences; Buprenorphine - administration & dosage; Buprenorphine - economics; Buprenorphine - therapeutic use; Cost of Illness; Cost-Benefit Analysis; Decision Support Techniques; Desintoxication. Drug withdrawal; Drug addiction; Drug Administration Schedule; Drug Combinations; Drug Costs - statistics & numerical data; General aspects; Health Care Costs - statistics & numerical data; Health care expenditures; Humans; Internal Medicine; Long-Term Care - economics; Long-Term Care - methods; Medical sciences; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Naloxone - administration & dosage; Naloxone - economics; Naloxone - therapeutic use; Narcotic Antagonists - economics; Narcotic Antagonists - therapeutic use; Opiate Substitution Treatment - economics; Opiate Substitution Treatment - methods; Opioid-Related Disorders - economics; Opioid-Related Disorders - rehabilitation; Original Research; Primary care; Primary Health Care - economics; Primary Health Care - methods; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality-Adjusted Life Years; Sensitivity analysis; Sensitivity and Specificity; Substance abuse treatment; Treatments; United States
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-011-1962-8

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.