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


METHODS
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.


RESULTS
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.
Barnett
P G
PG
Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA and the Department of Health Research and Policy, Stanford University, Stanford, CA, USA. paul.barnett@med.va.gov
Zaric
G S
GS
Brandeau
M L
ML
D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006801:Humans; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics* / Q000534:rehabilitation; D019057:Quality-Adjusted Life Years; D014481:United States
D009292:Narcotic Antagonists; D002047:Buprenorphine