Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care.
BACKGROUND
Primary care physicians with appropriate training may prescribe buprenorphine-naloxone (bup/nx) to treat opioid dependence in US office-based settings, where many patients prefer to be treated. Bup/nx is off patent but not available as a generic.


OBJECTIVE
We evaluated the cost-effectiveness of long-term office-based bup/nx treatment for clinically stable opioid-dependent patients compared to no treatment.


METHODS
A decision analytic model simulated a hypothetical cohort of clinically stable opioid-dependent individuals who have already completed 6 months of office-based bup/nx treatment. Data were from a published cohort study that collected treatment retention, opioid use, and costs for this population, and published quality-of-life weights. Uncertainties in estimated monthly costs and quality-of-life weights were evaluated in probabilistic sensitivity analyses, and the economic value of additional research to reduce these uncertainties was also evaluated.


METHODS
Bup/nx, provider, and patient costs in 2010 US dollars, quality-adjusted life years (QALYs), and incremental cost-effectiveness (CE) ratios ($/QALY); costs and QALYs are discounted at 3% annually.


RESULTS
In the base case, office-based bup/nx for clinically stable patients has a CE ratio of $35,100/QALY compared to no treatment after 24 months, with 64% probability of being < $100,000/QALY in probabilistic sensitivity analysis. With a 50% bup/nx price reduction the CE ratio is $23,000/QALY with 69% probability of being < $100,000/QALY. Alternative quality-of-life weights result in CE ratios of $138,000/QALY and $90,600/QALY. The value of research to reduce quality-of-life uncertainties for 24-month results is $6,400 per person eligible for treatment at the current bup/nx price and $5,100 per person with a 50% bup/nx price reduction.


CONCLUSIONS
Office-based bup/nx for clinically stable patients may be a cost-effective alternative to no treatment at a threshold of $100,000/QALY depending on assumptions about quality-of-life weights. Additional research about quality-of-life benefits and broader health system and societal cost savings of bup/nx therapy is needed.
Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, USA. brs2006@med.cornell.edu
Bruce R
BR
Schackman
Jared A
JA
Leff
Daniel
D
Polsky
Brent A
BA
Moore
David A
DA
Fiellin
D002047:Buprenorphine / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D004338:Drug Combinations; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D009270:Naloxone / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics* / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000379:methods; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D011320:Primary Health Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014481:United States; D016903:Drug Monitoring
D004338:Drug Combinations; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine