Cost of pharmacotherapy for opioid use disorders following inpatient detoxification.
Addressing opioid use disorder (OUD), heroin and fentanyl use, and escalating rates of overdose deaths in the United States is a top priority. FDA-approved medications to treat OUD include methadone, buprenorphine, and naltrexone. Both naltrexone and buprenorphine have short- and long-acting formulations, and, unlike methadone, which can be dispensed only from approved facilities, naltrexone and buprenorphine can be prescribed in office-based settings by physicians or other prescribing providers. As new evidence regarding the effectiveness and cost-effectiveness of these treatment is established, providers, payers, and other stakeholders need to understand the resources and associated costs of implementation and ongoing provision of different treatment models.
This study describes the approach and results of a comprehensive multisite cost analysis of the first head-to-head randomized clinical trial in the U.S. of extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) for preventing opioid relapse (NIDA Clinical Trials Network study CTN-0051). Cost data were collected for 3 intervention phases: program start-up, inpatient detoxification, and up to 24 weeks of medication induction and management visits (post detoxification). Cost analyses were from the healthcare sector perspective (2015 US$); patient costs are also reported. Site visits were conducted, with a cost survey administered to each of the 8 participating treatment programs, and study data on medication and services utilization were analyzed. Nationally representative sources were used to estimate unit costs. Uncertainty was evaluated in sensitivity analyses.
Analysis revealed that mean start-up costs were $1071 per program for XR-NTX and $828 per program for BUP-NX. Mean costs per participant were $5416 for XR-NTX (57% detoxification, 37% medication, 3% provider, 3% patient) and $4148 for BUP-NX (64% detoxification, 12% medication, 10% provider, 14% patient). Total cost per participant ranged by site from $2979 to $8963 for XR-NTX and from $2521 to $6486 for BUP-NX.
Conclusions: For treatment providers, offering XR-NTX and/or BUP-NX as part of existing detoxification treatment modalities generates modest costs in addition to the costs of detoxification, which vary substantially among the 8 sites. From the patient’s perspective, the costs associated with medication management visits may be a barrier for some individuals considering these treatments.
Related protocols: CTN-0051