Cost-effectiveness of extended-release naltrexone versus buprenorphine-naloxone to prevent opioid relapse.

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 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