Cost-effectiveness implications of increasing the efficiency of the extended-release naltrexone induction process for the treatment of opioid use disorder: A secondary analysis.
In a United States randomized-effectiveness trial comparing extended release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation XR-NTX (72% XR-NTX vs 94% BUP-NX). This led to higher relapse rates and average healthcare costs among XR-NTX participants. This study, a secondary analysis of data from CTN-0051, estimated the extent to which a more efficient model of XR-NTX induction would improve the economic value of XR-NTX relative to BUP-NX.
The analysis looked at 283 participants randomized to receive XR-NTX and included follow-up data over 24-36 weeks. Efficiency was estimated using a multivariable generalized-structural-equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification + residential days). Cost-effectiveness was estimated from the healthcare sector perspective and included expected costs and quality-adjusted life-years (QALYs).
The study revealed that treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework reduced the incremental average 24-week total cost of XR-NTX treatment from $5,317 more than that of BUP-NX to a non-statistically significant difference of $1,016. QALYs gained remained similar across arms.
Conclusions: Adopting an efficient model of extended-release naltrexone initiation could result in XR-NTX and BUP-NX being of comparable economic value from the healthcare sector perspective over 24-26 weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.
Related protocols: CTN-0051