title: Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.
abstract: OBJECTIVE
  To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.
  
  
  METHODS
  We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.
  
  
  METHODS
  Muar, Malaysia.
  
  
  METHODS
  126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.
  
  
  METHODS
  Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.
  
  
  RESULTS
  Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.
  
  
  CONCLUSIONS
  Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.
authors.affiliation: Department of Public Health, School of Medicine, Yale University, New Haven, Connecticut, United States of America. jennifer.ruger@yale.edu
authors.forename: Jennifer Prah
authors.initials: JP
authors.lastname: Ruger
authors.forename: Marek
authors.initials: M
authors.lastname: Chawarski
authors.forename: Mahmud
authors.initials: M
authors.lastname: Mazlan
authors.forename: Nora
authors.initials: N
authors.lastname: Ng
authors.forename: Richard
authors.initials: R
authors.lastname: Schottenfeld
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000453:epidemiology; D002047:Buprenorphine / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006556:Heroin Dependence / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D009271:Naltrexone / Q000191:economics* / Q000627:therapeutic use*; D012307:Risk Factors; D012309:Risk-Taking; D016896:Treatment Outcome
chemical_list: D002047:Buprenorphine; D009271:Naltrexone