Cost-Effectiveness of Injectable Extended-Release Naltrexone Compared with Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence

Jackson, Heide; Mandell, Kara; Johnson, Kimberly; Chatterjee, Debanjana; Vanness, David J.

doi:10.1080/08897077.2015.1010031

Cited by 54 publications

(29 citation statements)

References 29 publications

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“…Jackson et al[67] developed a Markov model to estimate the cost-effectiveness of injectable XR-NTX relative to MMT and BMT for U.S. adult males receiving therapy for an opioid use disorder. From the perspective of state addiction treatment payers, the estimated cost-effectiveness ratio was $72 [∼2014 USD] per opioid-free day relative to the next most effective treatment, MMT.…”

Section: Resultsmentioning

confidence: 99%

“…A number of studies compared MMT to other pharmacological therapies, including injectable heroin,[64, 65] BMT,[21, 31, 32, 66, 67] and naltrexone. [67] As can be seen in Table 6, all but one of these studies was rated as good.…”

Section: Discussionmentioning

confidence: 99%

“…[67] As can be seen in Table 6, all but one of these studies was rated as good. With regard to injectable heroin, Nosyk et al[64] found that it dominated MMT, while Byford et al[65] found that to be the case for oral methadone, but found injectable heroin to be slightly less cost-effective than injectable methadone.…”

Section: Discussionmentioning

confidence: 99%

“…Geitona et al[32] found BMT to be significantly less expensive than MMT from the Greek National Health System's perspective, and more effective with regard to participants completing therapy and deaths avoided. Finally, Jackson et al[67] found MMT to dominate BMT with regard to costs from a state-addiction-treatment-payer perspective and an outcome measure of opioid-free days.…”

Section: Discussionmentioning

confidence: 99%

“…[67, 70] As indicated in Table 6, the quality of these studies was good . In general the results from these studies favored BMT.…”

Section: Discussionmentioning

confidence: 99%

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Economic Evaluations of Opioid Use Disorder Interventions

Murphy

Polsky

2016

PharmacoEconomics

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Background The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance-use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage the adoption of a given therapy, nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. Objective The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. Methods We performed a systematic review of the major electronic databases from inception until present (August 2015). A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic-evaluation studies according to their quality. Results A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n=49) were included in this study. Six of the included articles were review in nature. The remaining 43 articles performed an economic evaluation of an intervention for opioid use disorders. In general, the evidence on methadone-maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid-use-disorder therapy. The economic literature comparing MMT to other opioid-use-disorder pharmacotherapies is limited, as is the literature on other forms of therapy. Conclusions With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid-use-disorder interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[67, 70] As indicated in Table 6, the quality of these studies was good . In general the results from these studies favored BMT.…”

Section: Discussionmentioning

confidence: 99%

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Economic Evaluations of Opioid Use Disorder Interventions

Murphy

Polsky

2016

PharmacoEconomics

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Buprenorphine Opioid Treatment During the COVID-19 Pandemic

2021

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To the Editor To our knowledge, Nguyen et al 1 were the first group to report on the consequences of enabling telehealth initiation of buprenorphine for management of opioid use disorders (OUDs) during the COVID-19 crisis. We read with much excitement their results, which showed a plateau in buprenorphine prescriptions while overall drug prescriptions declined between March 2020 and June 2020. We believe that the trends they report shed light both on the boon of flexible prescription via telehealth and on some potential oversights to address moving forward. These include ensuring treatment initiation and continuation for the most vulnerable patients, who might not have access to telehealth, and surveilling access to other OUD medications through the pandemic.First, while the authors conclude that the change in policy could have allowed for retention in buprenorphine treatment, this might be a trade off between insured and uninsured patients. That is, while insured patients seem to continue treatment using telehealth, cash payers were the only ones to see their number for buprenorphine prescriptions decline significantly as compared with Medicare, Medicaid and commercial plans (Figure 2 1 and Table 1 ). Cash payers might encompass a subpopulation most vulnerable to the effects of this double pandemic. Among those most affected financially or otherwise by the pandemic (interruption of services, financial crises, etc) are users of multiple substances, 2 those of lower socioeconomic status, those newly released from incarceration as part of the current decarceration efforts, and those dependent on now-fractured community safety nets. 3 Among those also excluded from the new telemedicine policies are patients with OUD who rely on in-person methadone clinics. To complement the work done by Nguyen et al, 1 it would also be worthwhile to analyze how COVID-19 has affected the 350 000 Americans receiving methadone treatment. 4 To better understand the impact of COVID-19 on restricting access to opioid treatment, future studies may wish to explore trends in other treatment modalities which require in-person monitoring.In conclusion, Nguyen et al 1 present an interesting first evaluation of recent policy efforts to facilitate OUD management in the wake of the ongoing COVID-19 pandemic. As they report, increases in the flexibility of prescription via telemedicine is invaluable to promote retention of patients in treatment and improve drug compliance. This will surely extend past the current pandemic to include, for example, individuals living in rural areas or seeking an accelerated consultation. However, these trends seem to suggest other strategies will be necessary to prevent the most vulnerable individuals from falling through the cracks.

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Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder

Flam-Ross,

Marsh,

Weitz

et al. 2023

JAMA Netw Open

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ImportanceIn 2017, the US Food and Drug Administration (FDA) approved a monthly injectable form of buprenorphine, extended-release buprenorphine; published data show that extended-release buprenorphine is effective compared with no treatment, but its current cost is higher and current retention is lower than that of transmucosal buprenorphine. Preliminary research suggests that extended-release buprenorphine may be an important addition to treatment options, but the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine remains unclear.ObjectiveTo evaluate the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine.Design, Setting, and ParticipantsThis economic evaluation used a state transition model starting in 2019 to simulate the lifetime of a closed cohort of individuals with OUD presenting for evaluation for opioid agonist treatment with buprenorphine. The data sources used to estimate model parameters included cohort studies, clinical trials, and administrative data. The model relied on pharmaceutical costs from the Federal Supply Schedule and health care utilization costs from published studies. Data were analyzed from September 2021 to January 2023.InterventionsNo treatment, treatment with transmucosal buprenorphine, or treatment with extended-release buprenorphine.Main Outcomes and MeasuresMean lifetime costs per person, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).ResultsThe simulated cohort included 100 000 patients with OUD receiving (61% male; mean [SD] age, 38 [11] years) or not receiving medication treatment (58% male, mean [SD] age, 48 [18] years). Compared with no medication treatment, treatment with transmucosal buprenorphine yielded an ICER of $19 740 per QALY. Compared with treatment with transmucosal buprenorphine, treatment with extended-release buprenorphine yielded lower effectiveness by 0.03 QALYs per person at higher cost, suggesting that treatment with extended-release buprenorphine was dominated and not preferred. In probabilistic sensitivity analyses, treatment with transmucosal buprenorphine was the preferred strategy 60% of the time. Treatment with extended-release buprenorphine was cost-effective compared with treatment with transmucosal buprenorphine at a $100 000 per QALY willingness-to-pay threshold only after substantial changes in key parameters.Conclusions and RelevanceIn this economic evaluation of extended-release buprenorphine compared with transmucosal buprenorphine for the treatment of OUD, extended-release buprenorphine was not associated with efficient allocation of limited resources when transmucosal buprenorphine was available. Future initiatives should aim to improve retention rates or decrease costs associated with extended-release buprenorphine.

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Cost-Effectiveness of Injectable Extended-Release Naltrexone Compared with Methadone Maintenance and Buprenorphine Maintenance Treatment for Opioid Dependence

Cited by 54 publications

References 29 publications

Economic Evaluations of Opioid Use Disorder Interventions

Economic Evaluations of Opioid Use Disorder Interventions

Buprenorphine Opioid Treatment During the COVID-19 Pandemic

Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder

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