A critical appraisal of the Australian comparative trial of methadone and buprenorphine maintenance.
While there are serious problems with the analyses and reports, the Australian comparative trial of methadone and buprenorphine maintenance has generated very useful data. Contrary to the triallists' conclusions, their study provides good evidence that methadone is better than buprenorphine at retaining addicts in programmes where clinicians can adjust their patients' daily doses. The trial also provides the first evidence that methadone is significantly cheaper than buprenorphine maintenance. The savings from less frequent clinic attendance were more than offset by the extra time spent dispensing buprenorphine and the greater cost of the buprenorphine itself. In cost-effectiveness terms, the trial's results show methadone 'dominates' buprenorphine as an opioid maintenance drug because it is not only more effective but also cheaper.
Caplehorn
John
J
Clinical Epidemiology, School of Public Health, University of Sydney, Australia. jcaleho@bigpond.net.au
Deeks
Jonathan J
JJ
D001315:Australia / Q000453:epidemiology; D002047:Buprenorphine / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage* / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
D002047:Buprenorphine; D008691:Methadone