title: Management of opioid-dependent patients: comparison of the cost associated with use of buprenorphine/naloxone or methadone, and their interactions with concomitant treatments for infectious or psychiatric comorbidities.
abstract: The objective was to estimate the annual interaction management cost of agonist opioid treatment (AOT) for opioid-dependent (OD) patients with buprenorphine-naloxone (Suboxone®) (B/N) or methadone associated with concomitant treatments for infectious (HIV) or psychiatric comorbidities. A costs analysis model was developed to calculate the associated cost of AOT and interaction management. The AOT cost included pharmaceutical costs, drug preparation, distribution and dispensing, based on intake regimen (healthcare center or take-home) and type and frequency of dispensing (healthcare center or pharmacy), and medical visits. The cost of methadone also included single-dose bottles, monthly costs of custody at pharmacy, urine toxicology drug screenings and nursing visits. Potential interactions between AOT and concomitant treatments (antivirals, antibacterials/antifungals, antipsychotics, anxiolytics, antidepressant and anticonvulsants), were identified to determine the additional use of healthcare resources for each interaction management. The annual cost per patient of AOT was €1,525.97 for B/N and €1,467.29 for methadone. The average annual cost per patient of interaction management was €257.07 (infectious comorbidities), €114.03 (psychiatric comorbidities) and €185.55 (double comorbidity) with methadone and €7.90 with B/N in psychiatric comorbidities. Total annual costs of B/N were €1,525.97, €1,533.87 and €1,533.87 compared to €1,724.35, €1,581.32 and €1,652.84 for methadone per patient with infectious, psychiatric or double comorbidity respectively.Compared to methadone, the total cost per patient with OD was lower with B/N (€47.45-€198.38 per year). This is due to the differences in interaction management costs associated with the concomitant treatment of infectious and/or psychiatric comorbidities.
authors.affiliation: CAS Drogodependencias Vall Hebron. Hospital Universitario Vall d'Hebron-ASPB. CIBERSAM. Departamento de Psiquiatría. Universidad Autónoma de Barcelona, Barcelona. croncero@vhebron.net.
authors.forename: Carlos
authors.initials: C
authors.lastname: Roncero
authors.forename: Raquel
authors.initials: R
authors.lastname: Domínguez-Hernández
authors.forename: Tomás
authors.initials: T
authors.lastname: Díaz
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Fernández
authors.forename: Rafael
authors.initials: R
authors.lastname: Forcada
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Martínez
authors.forename: Pedro
authors.initials: P
authors.lastname: Seijo
authors.forename: Antonio
authors.initials: A
authors.lastname: Terán
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics* / Q000627:therapeutic use*; D002047:Buprenorphine / Q000191:economics* / Q000627:therapeutic use*; D004347:Drug Interactions; D017048:Health Care Costs; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy*; D001523:Mental Disorders / Q000150:complications* / Q000188:drug therapy*; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use*; D009270:Naloxone / Q000191:economics* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000191:economics* / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics*
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone