title: Cost analysis of clinic and office-based treatment of opioid dependence: results with methadone and buprenorphine in clinically stable patients.
abstract: The cost of providing and receiving treatment for opioid dependence can determine its adoption. To compare the cost of clinic-based methadone (MC, n=23), office-based methadone (MO, n=21), and office-based buprenorphine (BO, n=34) we performed an analysis of treatment and patient costs over 6 months of maintenance in patients who had previously been stabilized for at least 1 year. We performed statistical comparisons using ANOVA and chi-square tests and performed a sensitivity analysis varying cost estimates and intensity of clinical contact. The cost of providing 1 month of treatment per patient was $147 (MC), $220 (MO) and $336 (BO) (p<0.001). Mean monthly medication cost was $93 (MC), $86 (MO) and $257 (BO) (p<0.001). The cost to patients was $92 (MC), $63 (MO) and $38 (BO) (p=0.102). Sensitivity analyses, varying cost estimates and clinical contact, result in total monthly costs of $117 to $183 (MC), $149 to $279 (MO), $292 to $499 (BO). Monthly patient costs were $84 to $133 (MC), $55 to $105 (MO) and $34 to $65 (BO). We conclude that providing clinic-based methadone is least expensive. The price of buprenorphine accounts for a major portion of the difference in costs. For patients, office-based treatment may be less expensive.
authors.affiliation: Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, 333 Cedar St., P.O. Box 208025, New Haven, CT, United States.
authors.forename: Emlyn S
authors.initials: ES
authors.lastname: Jones
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.forename: Jody L
authors.initials: JL
authors.lastname: Sindelar
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schottenfeld
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000293:Adolescent; D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D005260:Female; D006282:Health Personnel / Q000191:economics; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000191:economics* / Q000534:rehabilitation*; D010824:Physicians' Offices / Q000191:economics; D012959:Socioeconomic Factors; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone