Cost-Effectiveness of Buprenorphine-Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse.

Abstract

Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder. To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone. Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs. Study instruments. Adults with opioid use disorder. 24-week intervention with an additional 12 weeks of observation. Health care sector and societal. Buprenorphine-naloxone and extended-release naltrexone. Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids. Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine-naloxone to be preferable to extended-release naltrexone in 97% of bootstrap replications at 24 weeks and in 85% at 36 weeks. Similar results were obtained with incremental time abstinent from opioids as an outcome and with use of the societal perspective. The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation. Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs. Buprenorphine-naloxone is preferred to extended-release naltrexone as first-line treatment when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone. National Institute on Drug Abuse, National Institutes of Health.