TY - JOUR
KW - Buprenorphine/administration & dosage/economics/therapeutic use
KW - Cost of Illness
KW - Cost-Benefit Analysis
KW - Decision Support Techniques
KW - Drug Administration Schedule
KW - Drug Combinations
KW - Drug Costs/statistics & numerical data
KW - Health Care Costs/statistics & numerical data
KW - Humans
KW - Long-Term Care/economics/methods
KW - Medication Adherence/statistics & numerical data
KW - Naloxone/administration & dosage/economics/therapeutic use
KW - Narcotic Antagonists/economics/therapeutic use
KW - Opiate Substitution Treatment/economics/methods
KW - Opioid-Related Disorders/economics/rehabilitation
KW - Primary Health Care/economics/methods
KW - Quality-Adjusted Life Years
KW - Sensitivity and Specificity
KW - United States
AU - B. R. Schackman
AU - J. A. Leff
AU - D. Polsky
AU - B. A. Moore
AU - D. A. Fiellin
A1 - 
AB - BACKGROUND: Primary care physicians with appropriate training may prescribe buprenorphine-naloxone (bup/nx) to treat opioid dependence in US office-based settings, where many patients prefer to be treated. Bup/nx is off patent but not available as a generic. OBJECTIVE: We evaluated the cost-effectiveness of long-term office-based bup/nx treatment for clinically stable opioid-dependent patients compared to no treatment. DESIGN, SUBJECTS, AND INTERVENTION: A decision analytic model simulated a hypothetical cohort of clinically stable opioid-dependent individuals who have already completed 6 months of office-based bup/nx treatment. Data were from a published cohort study that collected treatment retention, opioid use, and costs for this population, and published quality-of-life weights. Uncertainties in estimated monthly costs and quality-of-life weights were evaluated in probabilistic sensitivity analyses, and the economic value of additional research to reduce these uncertainties was also evaluated. MAIN MEASURES: Bup/nx, provider, and patient costs in 2010 US dollars, quality-adjusted life years (QALYs), and incremental cost-effectiveness (CE) ratios ($/QALY); costs and QALYs are discounted at 3% annually. KEY RESULTS: In the base case, office-based bup/nx for clinically stable patients has a CE ratio of $35,100/QALY compared to no treatment after 24 months, with 64% probability of being < $100,000/QALY in probabilistic sensitivity analysis. With a 50% bup/nx price reduction the CE ratio is $23,000/QALY with 69% probability of being < $100,000/QALY. Alternative quality-of-life weights result in CE ratios of $138,000/QALY and $90,600/QALY. The value of research to reduce quality-of-life uncertainties for 24-month results is $6,400 per person eligible for treatment at the current bup/nx price and $5,100 per person with a 50% bup/nx price reduction. CONCLUSIONS: Office-based bup/nx for clinically stable patients may be a cost-effective alternative to no treatment at a threshold of $100,000/QALY depending on assumptions about quality-of-life weights. Additional research about quality-of-life benefits and broader health system and societal cost savings of bup/nx therapy is needed.
BT - Journal of general internal medicine
C5 - Opioids & Substance Use; Financing & Sustainability
CP - 6
CY - United States
DO - 10.1007/s11606-011-1962-8
IS - 6
JF - Journal of general internal medicine
N2 - BACKGROUND: Primary care physicians with appropriate training may prescribe buprenorphine-naloxone (bup/nx) to treat opioid dependence in US office-based settings, where many patients prefer to be treated. Bup/nx is off patent but not available as a generic. OBJECTIVE: We evaluated the cost-effectiveness of long-term office-based bup/nx treatment for clinically stable opioid-dependent patients compared to no treatment. DESIGN, SUBJECTS, AND INTERVENTION: A decision analytic model simulated a hypothetical cohort of clinically stable opioid-dependent individuals who have already completed 6 months of office-based bup/nx treatment. Data were from a published cohort study that collected treatment retention, opioid use, and costs for this population, and published quality-of-life weights. Uncertainties in estimated monthly costs and quality-of-life weights were evaluated in probabilistic sensitivity analyses, and the economic value of additional research to reduce these uncertainties was also evaluated. MAIN MEASURES: Bup/nx, provider, and patient costs in 2010 US dollars, quality-adjusted life years (QALYs), and incremental cost-effectiveness (CE) ratios ($/QALY); costs and QALYs are discounted at 3% annually. KEY RESULTS: In the base case, office-based bup/nx for clinically stable patients has a CE ratio of $35,100/QALY compared to no treatment after 24 months, with 64% probability of being < $100,000/QALY in probabilistic sensitivity analysis. With a 50% bup/nx price reduction the CE ratio is $23,000/QALY with 69% probability of being < $100,000/QALY. Alternative quality-of-life weights result in CE ratios of $138,000/QALY and $90,600/QALY. The value of research to reduce quality-of-life uncertainties for 24-month results is $6,400 per person eligible for treatment at the current bup/nx price and $5,100 per person with a 50% bup/nx price reduction. CONCLUSIONS: Office-based bup/nx for clinically stable patients may be a cost-effective alternative to no treatment at a threshold of $100,000/QALY depending on assumptions about quality-of-life weights. Additional research about quality-of-life benefits and broader health system and societal cost savings of bup/nx therapy is needed.
PP - United States
PY - 2012
SN - 1525-1497; 0884-8734
SP - 669
EP - 676
EP - 
T1 - Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care
T2 - Journal of general internal medicine
TI - Cost-effectiveness of long-term outpatient buprenorphine-naloxone treatment for opioid dependence in primary care
U1 - Opioids & Substance Use; Financing & Sustainability
U2 - 22215271
U3 - 10.1007/s11606-011-1962-8
VL - 27
VO - 1525-1497; 0884-8734
Y1 - 2012
ER -