Abstract
BACKGROUND: Not enough evidence exists to compare buprenorphine-naloxone with extended-release naltrexone for treating opioid use disorder. OBJECTIVE: To evaluate the cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone. DESIGN: Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs. DATA SOURCES: Study instruments. TARGET POPULATION: Adults with opioid use disorder. TIME HORIZON: 24-week intervention with an additional 12 weeks of observation. PERSPECTIVE: Health care sector and societal. INTERVENTIONS: Buprenorphine-naloxone and extended-release naltrexone. OUTCOME MEASURES: Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids. RESULTS OF BASE-CASE ANALYSIS: 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. RESULTS OF SENSITIVITY ANALYSIS: The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation. LIMITATION: Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs. CONCLUSION: 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. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse, National Institutes of Health.