Sean M. Murphy, PhD; Kathryn E. McCollister, PhD, MA; Jared A. Leff, MS; Xuan Yang, MPH, MHS; Philip J. Jeng, MS; Joshua D. Lee, MD, MSc; Edward V. Nunes, MD; Patricia Novo, MPA, MPH; John Rotrosen, MD; Bruce R. Schackman, PhD, MBA
Note: The corresponding author had full access to all the data and had final responsibility for the decision to submit the manuscript for publication.
Grant Support: By grants R01DA035808 and P30DA040500 from the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH); U10DA013046, UG1/U10DA013035, UG1/U10DA013034, U10DA013045, UG1/U10DA013720, UG1/U10DA013732, UG1/U10DA013714, UG1/U10DA015831, U10DA015833, HHSN271201200017C and HHSN271201500065C from the NIDA National Drug Abuse Treatment Clinical Trials Network; and K24DA022412 (to Dr. Nunes).
Disclosures: Dr. Murphy reports grants from NIH during the conduct of the study. Ms. Novo reports grants from NIDA during the conduct of the study and outside the submitted work. Dr. Rotrosen reports grants from NIDA/NIH, medication for the present study from Indivior, and medication and/or funds for other studies (as principle investigator or investigator) from Indivior and Alkermes. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0227.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Murphy (e-mail, firstname.lastname@example.org). Data set: Available in accordance with NIDA National Drug Abuse Treatment Clinical Trials Network policy (https://datashare.nida.nih.gov).
Corresponding Author: Sean M. Murphy, PhD, Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065; e-mail, email@example.com.
Current Author Addresses: Drs. Murphy and Schackman, Mr. Leff, and Mr. Jeng: Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065.
Dr. McCollister and Ms. Yang: University of Miami Miller School of Medicine, Don Soffer Clinical Research Center, 1120 Northwest 14th Street, Suite 1019, Miami, FL 33136.
Dr. Lee: New York University School of Medicine, 227 East 30th Street, Suite 712, New York, NY 10016.
Dr. Nunes: Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032.
Ms. Novo and Dr. Rotrosen: Department of Psychiatry, New York University School of Medicine, One Park Avenue, 8th Floor, New York, NY 10016.
Author Contributions: Conception and design: S.M. Murphy, J.D. Lee, E.V. Nunes, J. Rotrosen, B.R. Schackman.
Analysis and interpretation of the data: S.M. Murphy, K.E. McCollister, J.A. Leff, X. Yang, J. Rotrosen, B.R. Schackman.
Drafting of the article: S.M. Murphy, K.E. McCollister, J.A. Leff, P.J. Jeng.
Critical revision for important intellectual content: J.A. Leff, J.D. Lee, E.V. Nunes, B.R. Schackman.
Final approval of the article: S.M. Murphy, K.E. McCollister, J.A. Leff, X. Yang, P.J. Jeng, J.D. Lee, E.V. Nunes, P. Novo, J. Rotrosen, B.R. Schackman.
Provision of study materials or patients: P. Novo, J. Rotrosen.
Statistical expertise: S.M. Murphy.
Obtaining of funding: K.E. McCollister, P. Novo, J. Rotrosen, B.R. Schackman.
Administrative, technical, or logistic support: J.A. Leff, P.J. Jeng, J. Rotrosen.
Collection and assembly of data: K.E. McCollister, J.A. Leff, X. Yang, P.J. Jeng, J.D. Lee, P. Novo, J. Rotrosen, B.R. Schackman.
Not enough evidence exists to compare buprenorphine–naloxone with extended-release naltrexone for treating opioid use disorder.
To evaluate the cost-effectiveness of buprenorphine–naloxone versus extended-release naltrexone.
Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs.
Adults with opioid use disorder.
24-week intervention with an additional 12 weeks of observation.
Health care sector and societal.
Buprenorphine–naloxone and extended-release naltrexone.
Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids.
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.
The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation.
Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs.
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.
National Institute on Drug Abuse, National Institutes of Health.
Murphy SM, McCollister KE, Leff JA, et al. Cost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med. 2019;170:90–98. [Epub ahead of print 18 December 2018]. doi: https://doi.org/10.7326/M18-0227
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Published: Ann Intern Med. 2019;170(2):90-98.
Published at www.annals.org on 18 December 2018
Healthcare Delivery and Policy, High Value Care, Hospital Medicine, Tobacco, Alcohol, and Other Substance Abuse.
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