The cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States

Addiction. 2001 Sep;96(9):1267-78. doi: 10.1046/j.1360-0443.2001.96912676.x.


Aims: To determine the cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States, particularly its effect on the HIV epidemic.

Design: We developed a dynamic model to capture the effects of adding buprenorphine maintenance to the current opiate dependence treatment system. We evaluated incremental costs, including all health-care costs, and incremental effectiveness, measured as quality-adjusted life years (QALYs) of survival. We considered communities with HIV prevalence among injection drug users of 5% and 40%. Because no price has been set in the United States for a dose of buprenorphine, we considered three prices per dose: $5, $15, and $30.

Findings: If buprenorphine increases the number of individuals in maintenance treatment by 10%, but does not affect the number of individuals receiving methadone maintenance, the cost-effectiveness ratios for buprenorphine maintenance therapy are less than $45 000 per QALY gained for all prices, in both the low-prevalence and high-prevalence communities. If the same number of individuals enter buprenorphine maintenance (10% of the number currently in methadone), but half are injection drug users newly entering maintenance and half are individuals who switched from methadone to buprenorphine, the cost-effectiveness ratios in both communities are less than $45 000 per QALY gained for the $5 and $15 prices, and greater than $65 000 per QALY gained for the $30 price.

Conclusions: At a price of $5 or less per dose, buprenorphine maintenance is cost-effective under all scenarios we considered. At $15 per dose, it is cost-effective if its adoption does not lead to a net decline in methadone use, or if a medium to high value is assigned to the years of life lived by injection drug users and those in maintenance therapy. At $30 per dose, buprenorphine will be cost-effective only under the most optimistic modeling assumptions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Buprenorphine / economics
  • Buprenorphine / therapeutic use*
  • Cost-Benefit Analysis
  • Humans
  • Narcotic Antagonists / economics
  • Narcotic Antagonists / therapeutic use*
  • Opioid-Related Disorders / economics*
  • Opioid-Related Disorders / rehabilitation
  • Quality-Adjusted Life Years
  • United States


  • Narcotic Antagonists
  • Buprenorphine