Cost analysis of clinic and office-based treatment of opioid dependence: Results with methadone and buprenorphine in clinically stable patients

Abstract

The cost of providing and receiving treatment for opioid dependence can determine its adoption. To compare the cost of clinic-based methadone (MC, n=23), office-based methadone (MO, n=21), and office-based buprenorphine (BO, n=34) we performed an analysis of treatment and patient costs over 6 months of maintenance in patients who had previously been stabilized for at least one year. We performed statistical comparisons using ANOVA and chi-square tests and performed a sensitivity analysis varying cost estimates and intensity of clinical contact. The cost of providing one month of treatment per patient was $147 (MC), $220 (MO) and $336 (BO) (p<0.001). Mean monthly medication cost was $93 (MC), $86 (MO) and $257 (BO) (p<0.001). The cost to patients was $92 (MC), $63 (MO) and $38 (BO) (p=0.102). Sensitivity analyses, varying cost estimates and clinical contact, result in total monthly costs of $117 to $183 (MC), $149 to $279 (MO), $292 to $499(BO). Monthly patient costs were $84 to $133 (MC), $55 to $105 (MO) and $34 to $65 (BO). We conclude that providing clinic-based methadone is least expensive. The price of buprenorphine accounts for a major portion of the difference in costs. For patients, office-based treatment may be less expensive.

Effect of Incarceration History on Outcomes of Primary Care Office-based Buprenorphine/Naloxone

“…Buprenorphine/naloxone treatment may be particularly attractive because it provides greater privacy, is less stigmatized than receiving methadone treatment, and is similar to treatment for other chronic medical problems. However, in spite of its appeal and efficacy, providers caring for individuals with a history of incarceration should be aware of potential financial barriers to paying for buprenorphine/naloxone, 40,41 as well as structural ones to continuing buprenorphine/naloxone in correctional facilities.…”

Cost-Effectiveness of Long-Term Outpatient Buprenorphine-Naloxone Treatment for Opioid Dependence in Primary Care

“…31 Following methods used in that cost study, we applied local labor and fringe benefit rates for physicians and nurses to the visit durations to determine visit costs, adding an additional 22% of the cost to account for time lost due to missed visits and a 46% overhead rate. 31,32 A similar approach was used to calculate average monthly utilization and costs for urine toxicology tests from the study data, and we also assumed liver enzyme tests (alanine aminotransferase, aspartate aminotransferase) occurred every 3 months while in treatment. 25 Patient costs, including visit time, travel time, and monthly transportation costs, were derived from the previous cost study.…”

“…25 Patient costs, including visit time, travel time, and monthly transportation costs, were derived from the previous cost study. 31 Time costs were calculated by multiplying the duration of the visit and travel by the state minimum wage of $8.25 per hour, 33 as more than half of the cohort reported not having full-time employment. 25 …”

Opioid Dependence Treatment and Guidelines

“…29 One recent study found the cost of providing 1 month of treatment per patient was $147 in methadone clinic treatments, $220 in methadone office treatments, and $336 buprenorphine office treatments (P < 0.001). 30 Mean monthly medication cost was $93, $86, and $257, respectively (P < 0.001). The cost to patients was $92, $63, and $38, respectively (P = 0.102), demonstrating that while the overall cost of buprenorphine is higher, the cost to the patient for buprenorphine therapy is lower.…”

“…The cost to patients was $92, $63, and $38, respectively (P = 0.102), demonstrating that while the overall cost of buprenorphine is higher, the cost to the patient for buprenorphine therapy is lower. 30 Another analysis of 259 published articles of economic evaluations of treating opiate dependence found that most studies used narrow treatment perspectives and surrogate outcome measures, concluding that the quantity and quality of economic evaluations are limited, evidence on cost-effectiveness of psychosocially-assisted pharmacotherapy is virtually nonexistent, and that most economic evaluations of treatment options are limited in terms of the range of costs and benefits considered. 31 respectively.…”