Addiction 2010;105(9):1616-1624
Polsky, Daniel | Glick, Henry A. | Yang, Jianing | Subramaniam, Geetha A. | Poole, Sabrina A. | Woody, George E.
The objective of this study (ancillary protocol CTN-0010-A-1) was to estimate cost, net social cost, and cost-effectiveness in a clinical trial of buprenorphine-naloxone treatment versus brief detoxification in opioid-dependent youth (protocol CTN-0010). Patients were randomized to 12 weeks of buprenorphine-naloxone (BUP) or a 14-day buprenorphine taper (DETOX). All were offered twice-weekly drug counseling. The 12-week outpatient study treatment cost was $1514 higher for BUP relative to DETOX. However, one-year total direct medical cost was only $83 higher for BUP. The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical costs per quality-adjusted life year (QALY) and $25,049 in terms of outpatient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% change of being accepted as cost-effective for a threshold of $100,000 per QALY.
In conclusion, extended buprenorphine-naloxone treatment relative to brief buprenorphine detoxification is cost-effective in the US health-care system for the outpatient treatment of opioid-dependent youth. Extended BUP treatment may result in greater social benefits than brief detoxification and be of more value to the insurer because the effectiveness of treatment results in medical cost offsets not captured by the treatment program itself. This suggests there is an incentive within health insurance plans to cover the provision of these services. Similarly, the apparent reduction in crime-related costs in the BUP group is a benefit to society not captured by the health-care system's analyses. This finding suggests a role for public funding of effective treatment programs such as extended BUP treatment for opioid-dependent youth.
Keywords: Adolescents | Buprenorphine/Naloxone | Cost-effectiveness | CTN platform/ancillary study | Opioid dependence | Opioid detoxification | Pharmacological therapy | Suboxone | Young adults | Addiction (journal)
Document No: 518 ; PMID: 20626379 ; PMCID: PMC2967450
Submitted by: CTN Dissemination Librarians (7/29/2010)
