Cost-effectiveness of extended release naltrexone to prevent relapse among criminal justice-involved individuals with a history of opioid use disorder.
Cost-effectiveness of extended release naltrexone to prevent relapse among criminal justice-involved individuals with a history of opioid use disorder.
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DOI：
10.1111/add.13807
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
O'Brien CP
中科院分区：
文献类型：
--
作者：
Murphy SM;Polsky D;Lee JD;Friedmann PD;Kinlock TW;Nunes EV;Bonnie RJ;Gordon M;Chen DT;Boney TY;O'Brien CP
涉及刑事司法的人员极易发生阿片类药物复发和与过量有关的死亡。在最近的一项随机试验中，我们证明了缓释纳曲酮（XR-NTX; Vivitrol®）在预防有阿片类药物使用障碍史的美国刑事司法相关成年人阿片类药物复发中的有效性。XR-NTX的成本可能是采用的一个重大障碍。因此，考虑到生活质量的提高和下游成本的抵消是很重要的。我们的目的是估计XR-NTX与常规治疗（TAU）相比获得的每个质量调整生命年（QALY）的增量成本，并相对于普遍接受的值阈值进行评估；并估计每增加一年阿片类药物戒断的增量成本。从纳税人的角度对上述试点进行经济评价。参与者被随机分为25周XR-NTX注射组或TAU组；随访时间分别为52周和78周。美国东北走廊的五个研究地点。308名参与者被随机分配到XR-NTX （n=153）或TAU （n=155）。增量成本分别与增量经济和临床有效性指标、质量年和禁欲年相关。25周的qaly成本和禁欲年的数据分别为162,150美元和46,329美元。78周的数据是76,400美元/QALY和16,371美元/禁欲年。在25周时，我们可以10%确定XR-NTX在价值阈值为100,000美元/QALY时具有成本效益，62%确定为200,000美元/QALY。78周时，10万美元/QALY的成本效益概率为59%，20万美元/QALY的成本效益概率为76%。我们有95%的信心认为干预是“物有所值”的，25周时为90000美元/戒瘾年，78周时为500美元/戒瘾年。虽然缓释纳曲酮在增加质量调整生命年（QALYs）和戒断方面似乎有效，但由于注射价格高昂，使用普遍接受的QALYs值阈值似乎不具有成本效益。
Criminal-justice-involved persons are highly susceptible to opioid relapse and overdose-related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended release naltrexone (XR-NTX; Vivitrol®) in preventing opioid relapse among criminal-justice-involved U.S. adults with a history of opioid use disorder. The cost of XR-NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life, and downstream cost-offsets. Our aims were to estimate the incremental cost per quality-adjusted life-year (QALY) gained for XR-NTX versus treatment as usual (TAU), and evaluate it relative to generally-accepted value thresholds; and estimate the incremental cost per additional year of opioid abstinence. Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR-NTX injections or TAU; follow-up occurred at 52 and 78 weeks. Five study sites in the U.S. Northeast corridor. 308 participants were randomized to XR-NTX (n=153) or TAU (n=155). Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent-years, respectively. The 25-week cost-per-QALY and -abstinent-year figures were $162,150 and $46,329, respectively. The 78-week figures were $76,400/QALY and $16,371/abstinent-year. At 25 weeks, we can be 10% certain that XR-NTX is cost-effective at a value threshold of $100,000/QALY, and 62% certain at $200,000/QALY. At 78 weeks, the cost-effectiveness probabilities are 59% at $100,000/QALY and 76% at $200,000/QALY. We can be 95% confident that the intervention would be considered a “good-value” at $90,000/abstinent-year at 25 weeks, and $500/abstinent-year at 78 weeks. While extended release naltrexone appears to be effective in increasing both quality-adjusted life-years (QALYs) and abstinence, it does not appear to be cost-effective using generally-accepted value thresholds for QALYs, due to the high price of the injection.
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影响因子：
2.2
作者：
Lee, Joshua D.;Friedmann, Peter D.;O'Brien, Charles P.
通讯作者：
O'Brien, Charles P.
影响因子：
3
作者：
Braithwaite, R. Scott;Meltzer, David O.;Roberts, Mark S.
通讯作者：
Roberts, Mark S.
影响因子：
4.2
作者：
Magura, Stephen;Lee, Joshua D.;Rosenblum, Andrew
通讯作者：
Rosenblum, Andrew
DOI：
10.2989/17280583.2013.849607
发表时间：
2014-01-01
影响因子：
--
作者：
Murphy, Sean M.;McPherson, Sterling;Robinson, Kent
通讯作者：
Robinson, Kent
影响因子：
4.2
作者：
Mark, TL;Woody, GE;Kleber, HD
通讯作者：
Kleber, HD