Buprenorphine-naloxone may be more cost-effective than extended-release naltrexone as first-line treatment for opioid use disorder, according to a recent study published in Annals of Internal Medicine.
Researchers conducted this cost-effectiveness analysis on data from a previously published randomized clinical trial. The initial 24-week trial was conducted to analyze the efficacy of buprenorphine-naloxone and extended-release naltrexone in preventing relapse in a cohort of 570 individuals with opioid use disorder enrolled in an inpatient detoxification program (average age, 34 years). Results of this study indicated comparable efficacy of both treatments.
Cost per quality-adjusted life-year of both drugs was the primary outcome of the current analysis, which also included a 12-week postintervention observation period. Over 24 weeks of intervention, extended-release naltrexone was found to be associated with an additional $5317 (95% CI, $1162-$9472) in total costs (ie, costs for detoxification and treatment) on average, compared with buprenorphine-naloxone, a cost difference which was no longer significant at 36 weeks (total cost difference, $4512; 95% CI, -$3626 to $12,650).
Using a willingness-to-pay threshold of $100,000 per quality-adjusted life-year, the researchers determined that buprenorphine-naloxone was preferable to extended-release naltrexone in 97% and 85% of bootstrap replications at 24 and 36 weeks, respectively. Comparable results were observed with the outcome of incremental time of opioid abstinence. Study limitations include the inability to generalize to a broader population, site protocol variability, and comorbidity restrictions.
“Given the larger mean costs and lower mean effectiveness, the [incremental cost-effectiveness ratio] point estimates indicate that buprenorphine-naloxone is preferred to extended-release naltrexone from both the health care sector and societal perspectives,” noted the study authors.
Murphy SM, McCollister KE, Leff JA, et al. Cost-effectiveness of buprenorphine–naloxone versus extended-release naltrexone to prevent opioid relapse [published online December 18, 2018] Ann Intern Med. doi: 10.7326/M18-0227
This article originally appeared on Clinical Pain Advisor