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

J Gen Intern Med. 2012 Jun;27(6):669-76. doi: 10.1007/s11606-011-1962-8. Epub 2012 Jan 4.

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.

Trial registration: ClinicalTrials.gov NCT00078130.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Buprenorphine / administration & dosage
  • Buprenorphine / economics*
  • Buprenorphine / therapeutic use
  • Cost of Illness
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Drug Administration Schedule
  • Drug Combinations
  • Drug Costs / statistics & numerical data
  • Health Care Costs / statistics & numerical data
  • Humans
  • Long-Term Care / economics
  • Long-Term Care / methods
  • Medication Adherence / statistics & numerical data
  • 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*
  • Primary Health Care / economics*
  • Primary Health Care / methods
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • United States

Substances

  • Drug Combinations
  • Narcotic Antagonists
  • Naloxone
  • Buprenorphine

Associated data

  • ClinicalTrials.gov/NCT00078130