Sean Murphy, PhD | Cost-Effectiveness of BUP-NX vs XR-NTX to Prevent Opioid Relapse

Full article at: annals.org/aim/fullarticle/27...
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.