1. In this study, the authors observed that both office-based treatments for opioid-use disorder, buprenorphine-naloxone and naltrexone, were equally clinically effective and appropriate.
2. Daily medication of buprenorphine-naloxone was found to be less costly from a healthcare sector perspective in comparison to naltrexone.
Evidence Rating Level: 2 (Good)
Study Rundown: Opioid use disorder remains a significant medical concern. Approximately 27 million people in 2016 were reported to have an opioid use disorder worldwide. In the United States, it was reported that opioid misuse costed more than 500 billion dollars annually. Currently, the U.S. Food and Drug Administration (FDA) have approved three medications for first-line treatment of opioid use disorder: methadone, buprenorphine and naltrexone. Methadone is available only in strictly regulated clinics; however, buprenorphine and naltrexone can be prescribed in an office setting. The authors of this study aimed to investigate the cost effectiveness of monthly injections for opioid use disorder, extended-release naltrexone, with daily medication, buprenorphine-naloxone, in the treatment of opioid use disorder. Generally, they observed that daily medication was more cost-effective than monthly injections. The main limitation of this study was its short follow-up period, considering that opioid use disorder is a chronic, relapsing condition. Collectively, the study results indicated that since the medications were similarly effective, buprenorphine-naloxone was the preferred clinical first-line treatment from a cost-effective perspective.
Click to read the study, published today in Annals of Internal Medicine
Relevant Reading: Prescription Opioid Abuse in Chronic Pain
In-Depth [cost-effectiveness analysis]: The authors of this study conducted a cost-effectiveness analysis alongside a randomized clinical trial that was previously reported, consisting of 570 adults in 8 U.S. treatment centers for opioid use disorder. The study length included a 24-week intervention period, with 12 weeks of additional follow-up observation. The main outcomes included incremental costs combined with incremental quality-adjusted life-years (QALY) and time abstinent from opioids. The authors observed that the cost of participating in study-provided treatment for the extended-release naltrexone was significantly lower by $217 (CI, -$242 to -$192) looking at the societal perspective. However, overall, the authors found that buprenorphine-naloxone was preferable to the extended-release naltrexone in 97% of bootstrap replications at 24 weeks, considering the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY.
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