Cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone to prevent opioid relapse.
Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder. This study evaluated the cost-effectiveness of these two medications using data from NIDA Clinical Trials Network protocol CTN-0051, which examined their effectiveness for opioid use disorder treatment in inpatient detoxification or short-term residential treatment programs.
Costs were evaluated from 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 Life-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 has similar effectiveness compared to XR-NTX; higher detoxification and medication costs for XR-NTX were not offset by savings in other costs. The inclusion 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.
Related protocols: CTN-0051