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Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care.
J Gen Intern Med 2012; 27(6):669-76JG

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.

Authors+Show Affiliations

Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, USA. brs2006@med.cornell.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22215271

Citation

Schackman, Bruce R., et al. "Cost-effectiveness of Long-term Outpatient Buprenorphine-naloxone Treatment for Opioid Dependence in Primary Care." Journal of General Internal Medicine, vol. 27, no. 6, 2012, pp. 669-76.
Schackman BR, Leff JA, Polsky D, et al. Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care. J Gen Intern Med. 2012;27(6):669-76.
Schackman, B. R., Leff, J. A., Polsky, D., Moore, B. A., & Fiellin, D. A. (2012). Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care. Journal of General Internal Medicine, 27(6), pp. 669-76. doi:10.1007/s11606-011-1962-8.
Schackman BR, et al. Cost-effectiveness of Long-term Outpatient Buprenorphine-naloxone Treatment for Opioid Dependence in Primary Care. J Gen Intern Med. 2012;27(6):669-76. PubMed PMID: 22215271.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care. AU - Schackman,Bruce R, AU - Leff,Jared A, AU - Polsky,Daniel, AU - Moore,Brent A, AU - Fiellin,David A, Y1 - 2012/01/04/ PY - 2011/04/08/received PY - 2011/12/05/accepted PY - 2011/10/14/revised PY - 2012/1/5/entrez PY - 2012/1/5/pubmed PY - 2012/9/27/medline SP - 669 EP - 76 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 27 IS - 6 N2 - 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. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/22215271/Cost_effectiveness_of_long_term_outpatient_buprenorphine_naloxone_treatment_for_opioid_dependence_in_primary_care_ L2 - https://dx.doi.org/10.1007/s11606-011-1962-8 DB - PRIME DP - Unbound Medicine ER -