A comparison of buprenorphine treatment in clinic and primary care settings: a randomised trial.
OBJECTIVE
To compare outcomes, costs and incremental cost-effectiveness of heroin detoxification performed in a specialist clinic and in general practice.


METHODS
Randomised controlled trial set in a specialist outpatient drug treatment centre and six office-based general practices in inner city Sydney, Australia.


METHODS
115 people seeking treatment for heroin dependence, of whom 97 (84%) were reinterviewed at Day 8, and 78 (68%) at Day 91.


METHODS
Participants were randomly allocated to primary care or a specialist clinic, and received buprenorphine for 5 days for detoxification, then were offered either maintenance therapy with methadone or buprenorphine, relapse prevention with naltrexone, or counselling alone.


METHODS
Completion of detoxification, engagement in post-detoxification treatment, and heroin use assessed at Days 8 and 91. Costs relevant to providing treatment, including staff time, medication use and diagnostic procedures, with abstinence from heroin use on Day 8 as the primary outcome measure.


RESULTS
There were no significant differences in the proportions completing detoxification (40/56 [71%] primary care v 46/59 [78%] clinic), participating in postwithdrawal treatment (28/56 [50%] primary care v 36/59 [61%] clinic), reporting no opiate use during the withdrawal period (13/56 [23%] primary care v 13/59 [22%] clinic), and in duration of postwithdrawal treatment by survival analysis. Most participants in both groups entered postwithdrawal buprenorphine maintenance. On an intention-to-treat basis, self-reported heroin use in the month before the Day 91 interview was significantly lower than at baseline (27 days/month at baseline, 14 days/month at Day 91; P < 0.001) and did not differ between groups. Buprenorphine detoxification in primary care was estimated to be $24 more expensive per patient than treatment at the clinic. The incremental cost-effectiveness ratio reveals that, in this context, it costs $20 to achieve a 1% improvement in outcome in primary care.


CONCLUSIONS
Buprenorphine-assisted detoxification from heroin in specialist clinic and primary care settings had similar efficacy and cost-effectiveness. Buprenorphine treatment can be initiated safely in primary care settings by trained GPs.
Gibson
Amy E
AE
National Drug and Alcohol Research Centre, University of New South Wales, UNSW Randwick Campus, King Street, Randwick, NSW 2052, Australia. amy.gibson@unsw.edu.au
Doran
Christopher M
CM
Bell
James R
JR
Ryan
Anni
A
Lintzeris
Nicholas
N
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome
D002047:Buprenorphine