Cost-effectiveness of extended buprenorphine-naloxone treatment for opioid-dependent youth: data from a randomized trial

Abstract

Aims: The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine-naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth.

Design: Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling.

Participants: 152 patients aged 15-21 years.

Measurements: Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12.

Findings: The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25,049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100,000 per QALY.

Conclusions: Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth.

Trial registration: ClinicalTrials.gov NCT00078130.

Conflict of interest statement

Dr Woody is a member of the RADARS postmarketing study external advisory group whose job is to assess abuse of prescription medications. Denver Health administers RADARS and Abbott, Cephalon, Endo, Pricara/Ortho-NcNeil, Purdue Pharma, and Shire subscribe to its data. Ortho-McNeil and Purdue Pharma funded similar work by him prior to his joining RADARS and Schering-Plough, the European distributor for buprenorphine-naloxone, funded his travel costs to meetings in Sweden and Finland in June 2008 to present data from the study on whose outcomes this study is based. There are no other conflicts of interest to report. There are no contractual constraints on publishing imposed by the funder.

Figures

Figure 1

Sensitivity Analysis of Costs* *Baseline: Results from Table 1 which use GLM models. OLS: Results from Table 1 reproduced using ordinary least squares models. Site-specific: Costs of therapy and administration re-estimated with site-specific unit costs, rather than averages, estimated with OLS. 3mo fixed: Costs of therapy and administration re-estimated with study outpatient treatment program costs that include an allocation for fixed costs estimated with OLS. Generic: Study drug costs re-estimated at 30% of WAP price with OLS.

Figure 2

Acceptability Curves* *Acceptability curves for the cost per QALY calculated for 1 year of follow-up from the perspective of the substance abuse treatment program (dashed line) and the payer of health care services (solid line).