Poster presented at the College on Problems of Drug Dependence (CPDD) annual meeting, San Diego, CA, June 9-14, 2018.
Sean M. Murphy, PhD (Weill Cornell Medicine, GNY Node), Kathryn McCollister, PhD (University of Miami, FNA Node), Jared A. Leff (Weill Cornell Medical College, GNY Node), Xuan Yang (University of Miami, FNA Node), Philip J. Jeng (Weill Cornell Medical College, GNY Node), Joshua D. Lee, MD, MSc (New York University, GNY Node), Edward V. Nunes, MD (Columbia University, GNY Node), Patricia Novo, MPH (NYU School of Medicine, GNY Node), John Rotrosen, MD (NYU School of Medicine), Bruce R. Schackman, PhD (Weill Cornell Medical College, GNY Node).
This study evaluated the cost-effectiveness of extended-release naltrexone (XR-NTX) versus buprenorphine-naloxone (BUP-NX) alongside the recently completed U.S. randomized clinical trial testing their effectiveness in the prevention of opioid relapse as outpatient continuation after initiating treatment in an inpatient detoxification setting (CTN-0051). Costs were evaluated from the health care system and societal perspectives over the 24-week intervention and the 36-week observation period. Researchers estimated economic and clinical effectiveness outcomes (Quality-Adjusted Lief-Years (QALYs) and abstinent years) and compared incremental costs to incremental effectiveness. Sensitivity analyses included assuming a higher cost of XR-NTX ($1,309/injection vs. $704), and excluding participants who were not successfully initiated on their randomized treatment (i.e., per protocol).
Results found that the mean cost, per participant, of XR-NTX exceeded that of BUP-NX, including $427 greater study-provided detoxification cost and $1,250 greater study-provided medication/therapy cost, but the only statistically significant difference was from the health care system perspective at 24 weeks. Differences in effectiveness were not significant. Considering costs and effectiveness together, BUP-NX was preferred.
Conclusions: Data from this clinical trial indicate that BUP-NX is less costly from the health care system perspective and similar effective compared to XR-NTX; higher detoxification and medication costs for XR-NTX were not offset by savings in other costs. The includion of additional society perspective costs (criminal justice, productivity, and patient time and travel) introduced more uncertainty. Per protocol results were similar, indicating that among those initiating treatment, XR-NTX detoxification and medication costs remain important economic concerns. (Poster, PDF, English, 2018)
Keywords: Buprenorphine/Naloxone | Cost-effectiveness | Naltrexone | Opioid dependence | Pharmacological therapy | College on Problems of Drug Dependence (CPDD) annual meeting, 2018
Document No: 1321.
Submitted by Patricia Novo, GNY Node, 7/24/2018.