Cost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse

Abstract

Background: Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder.

Objective: To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone.

Design: Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs.

Data sources: Study instruments.

Target population: Adults with opioid use disorder.

Time horizon: 24-week intervention with an additional 12 weeks of observation.

Perspective: Health care sector and societal.

Interventions: Buprenorphine-naloxone and extended-release naltrexone.

Outcome measures: Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids.

Results of base-case analysis: Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine-naloxone to be preferable to extended-release naltrexone in 97% of bootstrap replications at 24 weeks and in 85% at 36 weeks. Similar results were obtained with incremental time abstinent from opioids as an outcome and with use of the societal perspective.

Results of sensitivity analysis: The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation.

Limitation: Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs.

Conclusion: Buprenorphine-naloxone is preferred to extended-release naltrexone as first-line treatment when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone.

Primary funding source: National Institute on Drug Abuse, National Institutes of Health.

Figure 1.

Cost-effectiveness acceptability curves (extended-release naltrexone vs. buprenorphine-naloxone)—intention-to-treat sample. Vertical lines represent recommended value thresholds (29). Willingness-to-pay thresholds are reported in 2016 U.S. dollars per QALY. QALY = quality-adjusted life-year.

Figure 2.

Cost-effectiveness acceptability curves (extended-release naltrexone vs. buprenorphine-naloxone)—per protocol sample. Vertical lines represent recommended value thresholds (29). Willingness-to-pay thresholds are reported in 2016 U.S. dollars per QALY. QALY = quality-adjusted life-year.