Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment
Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment
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DOI：
10.1503/cmaj.110669
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发表时间：
2012-04-03
影响因子：
14.6
通讯作者：
Anis, Aslam H.
中科院分区：
文献类型：
--
作者：
Nosyk, Bohdan;Guh, Daphne P.;Anis, Aslam H.
背景：虽然二乙酰吗啡已被证明比美沙酮维持治疗阿片类药物依赖更有效，但其直接成本更高。我们比较了二乙酰吗啡和美沙酮维持治疗对难治性慢性阿片类药物依赖的成本效益。方法：我们使用北美阿片类药物治疗计划试验的数据构建了半马尔可夫队列模型，并辅以不列颠哥伦比亚省的行政数据和其他已发表的数据，以捕捉阿片类药物依赖的慢性、复发性。我们计算了增量成本效益比，以比较二乙酰吗啡和美沙酮在 1 年、5 年、10 年和终生范围内的情况。结果：发现二乙酰吗啡在每个时间范围内都是优于美沙酮维持治疗的主导策略。我们的模型显示，在一生中，接受美沙酮治疗的人平均获得了 7.46 个折扣质量调整生命年 (QALY)（95% 可信区间 [CI] 6.91-8.01），并产生了 114 万美元的社会成本（95% CI 736 800-178 万美元）。接受二乙酰吗啡治疗的患者平均获得 7.92 个折扣 QALY（95% CI 7.32-8.53），并产生 110 万美元的社会成本（95% CI 724 100-171 万美元）。二乙酰吗啡队列的成本节省主要是因为与犯罪活动相关的成本减少。概率敏感性分析表明，在每获得 QALY 0 美元的支付意愿阈值下，二乙酰吗啡具有成本效益的概率为 76%；如果每获得 QALY 100,000 美元，则概率为 95%。结果通过一系列敏感性分析得到证实。解释：使用数学模型推断北美阿片药物治疗计划的结果，我们发现对于治疗难治性的慢性阿片类药物依赖患者，二乙酰吗啡可能比美沙酮更有效且成本更低。
Background: Although diacetylmorphine has been proven to be more effective than methadone maintenance treatment for opioid dependence, its direct costs are higher. We compared the cost-effectiveness of diacetylmorphine and methadone maintenance treatment for chronic opioid dependence refractory to treatment.Methods: We constructed a semi-Markov cohort model using data from the North American Opiate Medication Initiative trial, supplemented with administrative data for the province of British Columbia and other published data, to capture the chronic, recurrent nature of opioid dependence. We calculated incremental cost-effectiveness ratios to compare diacetylmorphine and methadone over 1-, 5-, 10-year and lifetime horizons.Results: Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each of the time horizons. Over a lifetime horizon, our model showed that people receiving methadone gained 7.46 discounted quality-adjusted life-years (QALYs) on average (95% credibility interval [CI] 6.91-8.01) and generated a societal cost of $1.14 million (95% CI $736 800-$1.78 million). Those who received diacetylmorphine gained 7.92 discounted QALYs on average (95% CI 7.32-8.53) and generated a societal cost of $1.10 million (95% CI $724 100-$1.71 million). Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity. Probabilistic sensitivity analysis showed that the probability of diacetylmorphine being cost-effective at a willingness-to-pay threshold of $0 per QALY gained was 76%; the probability was 95% at a threshold of $100 000 per QALY gained. Results were confirmed over a range of sensitivity analyses.Interpretation: Using mathematical modelling to extrapolate results from the North American Opiate Medication Initiative, we found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment.