TY - JOUR
KW - abuse
KW - Adult
KW - Ambulatory Care Facilities/economics
KW - Buprenorphine/administration & dosage/economics
KW - Cost-Benefit Analysis
KW - cost-effectiveness
KW - Humans
KW - Maintenance
KW - Markov Chains
KW - Methadone/administration & dosage/economics
KW - Opiate Substitution Treatment/economics/methods
KW - Opioid
KW - Opioid-Related Disorders/drug therapy
KW - Randomized Controlled Trials as Topic
KW - United States
AU - J. B. King
AU - A. M. Sainski-Nguyen
AU - B. K. Bellows
A1 - 
AB - The objective of this analysis was to compare the cost-effectiveness of clinic-based methadone maintenance therapy (MMT) and office-based buprenorphine maintenance therapy (BMT) from the perspective of third-party payers in the United States. The authors used a Markov cost-effectiveness model. A hypothetical cohort of 1000 adult, opioid-dependent patients was modeled over a 1-year time horizon. Patients were allowed to transition between the health states of in opioid dependence treatment and either abusing or not abusing opioids, or to have dropped out of treatment. Probabilities were derived from randomized clinical trials comparing methadone and buprenorphine. Costs included drug and administration, clinic visits, and therapy sessions. Effectiveness outcomes examined were (1) retention in the treatment program and (2) opioid abuse-free weeks. For retention in treatment at 1 year, MMT was more costly ($4,613 vs. $4,155) and more effective (20.3% vs. 15.9%) than BMT, resulting in an incremental cost-effectiveness ratio (ICER) of $10,437 per additional patient retained in treatment. MMT was also more effective than BMT in terms of opioid abuse-free weeks (9.2 vs. 9.1 weeks), resulting in an ICER of $8,515 per opioid abuse-free week gained. One-way sensitivity analyses found costs per week of MMT to have the largest impact on the retention-in-treatment outcome, whereas the probability of dropping out with MMT had the greatest impact on opioid abuse-free weeks. The authors conclude that MMT is cost-effective compared with BMT for the treatment of patients with opioid dependence. However, the treatment of substance abuse is complex, and decision makers should also consider individual patient characteristics when making coverage decisions.
BT - Journal of pain & palliative care pharmacotherapy
C5 - Opioids & Substance Use; Financing & Sustainability
CP - 1
CY - England
DO - 10.3109/15360288.2015.1135847
IS - 1
JF - Journal of pain & palliative care pharmacotherapy
N2 - The objective of this analysis was to compare the cost-effectiveness of clinic-based methadone maintenance therapy (MMT) and office-based buprenorphine maintenance therapy (BMT) from the perspective of third-party payers in the United States. The authors used a Markov cost-effectiveness model. A hypothetical cohort of 1000 adult, opioid-dependent patients was modeled over a 1-year time horizon. Patients were allowed to transition between the health states of in opioid dependence treatment and either abusing or not abusing opioids, or to have dropped out of treatment. Probabilities were derived from randomized clinical trials comparing methadone and buprenorphine. Costs included drug and administration, clinic visits, and therapy sessions. Effectiveness outcomes examined were (1) retention in the treatment program and (2) opioid abuse-free weeks. For retention in treatment at 1 year, MMT was more costly ($4,613 vs. $4,155) and more effective (20.3% vs. 15.9%) than BMT, resulting in an incremental cost-effectiveness ratio (ICER) of $10,437 per additional patient retained in treatment. MMT was also more effective than BMT in terms of opioid abuse-free weeks (9.2 vs. 9.1 weeks), resulting in an ICER of $8,515 per opioid abuse-free week gained. One-way sensitivity analyses found costs per week of MMT to have the largest impact on the retention-in-treatment outcome, whereas the probability of dropping out with MMT had the greatest impact on opioid abuse-free weeks. The authors conclude that MMT is cost-effective compared with BMT for the treatment of patients with opioid dependence. However, the treatment of substance abuse is complex, and decision makers should also consider individual patient characteristics when making coverage decisions.
PP - England
PY - 2016
SN - 1536-0539; 1536-0288
SP - 55
EP - 65
EP - 
T1 - Office-Based Buprenorphine Versus Clinic-Based Methadone: A Cost-Effectiveness Analysis
T2 - Journal of pain & palliative care pharmacotherapy
TI - Office-Based Buprenorphine Versus Clinic-Based Methadone: A Cost-Effectiveness Analysis
U1 - Opioids & Substance Use; Financing & Sustainability
U2 - 27007583
U3 - 10.3109/15360288.2015.1135847
VL - 30
VO - 1536-0539; 1536-0288
Y1 - 2016
ER -