Modeling the cost-effectiveness and impact on fatal overdose and initiation of buprenorphine-naloxone treatment at syringe service programs.
Modeling the cost-effectiveness and impact on fatal overdose and initiation of buprenorphine-naloxone treatment at syringe service programs.
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DOI：
10.1111/add.15883
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发表时间：
2022-10
期刊：
影响因子：
6
通讯作者：
Linas, Benjamin P.
中科院分区：
文献类型：
--
作者：
Adams, Joella W.;Savinkina, Alexandra;Fox, Aaron;Behrends, Czarina N.;Madushani, Rajapaksha W. M. A.;Wang, Jianing;Chatterjee, Avik;Walley, Alexander Y.;Barocas, Joshua A.;Linas, Benjamin P.
关键词：
估计在美国马萨诸塞州现有注射器服务项目（SSP）中，与提供丁丙诺啡-纳洛酮（丁丙诺啡）治疗相关的治疗启动次数、避免的致死性阿片类药物过量和成本效益。这是一个基于队列的数学模型和成本效益分析。我们从州和国家监测数据、临床试验和观察性队列研究中获得模型输入。我们比较了一种干预方案，其中30%的SSP客户每年至少一次在现场启动丁丙诺啡治疗，而现状方案是2020-30年马萨诸塞州社区治疗提供者中没有丁丙诺啡。在阿片类药物使用障碍（OUD）患者中，我们假设80%的SSP客户最近注射过药物，并且与标准治疗丁丙诺啡计划相比，SSP内的治疗将具有相似或改善的保留，但在治疗期间主动使用阿片类药物的比率更高。从卫生部门和有限的社会角度来看，开始治疗（即个人开始接受类阿片使用障碍药物治疗或进入药物管理戒断）、避免致命性类阿片过量、质量调整生命年和终身折扣成本的数量。在10年模拟期内，现状情景导致23 051例致命过量和1 511 613例治疗启动。现场SSP丁丙诺啡治疗的干预方案避免了4797例（−20.8%）致命的阿片类药物过量，与现状相比，导致129359例（+8.6%）额外的治疗启动。干预方案是主要方案：与现状方案相比，通过马萨诸塞州SSP提供OUD治疗的成本更低（每人-3612美元），患者积累了更多的QURs（每人0.2美元）。在注射器服务项目中提供丁丙诺啡现场治疗有可能大大减少致命的过量用药，提高治疗参与度并节省成本。
To estimate the number of treatment initiations, averted fatal opioid overdoses and the cost-effectiveness associated with offering buprenorphine–naloxone (buprenorphine) treatment on-site within existing syringe service programs (SSPs) in Massachusetts, USA. This was a cohort-based mathematical model and cost-effectiveness analysis. We derived model inputs from state and national surveillance data, clinical trials and observational cohort studies. We compared an intervention scenario where 30% of SSP clients initiated buprenorphine treatment on-site at least once annually to a status quo scenario where no buprenorphine was available on-site among community treatment providers in Massachusetts, 2020–30. In individuals with opioid use disorder (OUD) we assumed that 80% of SSP clients had recently injected drugs and that treatment within SSPs would have similar or improved retention compared with standard-of-care buprenorphine programs, but higher rates of active opioid use while in treatment. Number of treatment initiations (i.e. individuals began treatment on a medication for opioid use disorder or entered medically managed withdrawal), averted fatal opioid overdoses, quality-adjusted life-years (QALYs) and life-time discounted costs from a health sector and a limited societal perspective. The status quo scenario resulted in 23 051 fatal overdoses and 1 511 613 treatment initiations over a 10-year simulation period. An intervention scenario with on-site SSP buprenorphine treatment averted 4797 (−20.8%) fatal opioid overdoses and resulted in 129 359 (+8.6%) additional treatment initiations compared with the status quo. The intervention scenario was the dominating scenario: providing OUD treatment through Massachusetts SSPs cost less (−$3612 per person) with patients accumulating more QALYs (0.2 per person) compared with the status quo scenario. Offering buprenorphine treatment on-site within syringe service programs has the potential to decrease fatal overdoses substantially, improve treatment engagement and save on costs.
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影响因子：
12.7
作者：
Langendam, MW;van Brussel, GHA;van Ameijden, EJC
通讯作者：
van Ameijden, EJC
影响因子：
6.7
作者：
Fatseas, M;Auriacombe, Marc
通讯作者：
Auriacombe, Marc
DOI：
10.1097/phh.0000000000000514
发表时间：
2017-09-01
影响因子：
3.3
作者：
Jiang, Yongwen;McDonald, James V.;Alexander-Scott, Nicole
通讯作者：
Alexander-Scott, Nicole
影响因子：
3.9
作者：
Bailey GL;Herman DS;Stein MD
通讯作者：
Stein MD
影响因子：
9.3
作者：
Husereau D;Drummond M;Augustovski F;de Bekker-Grob E;Briggs AH;Carswell C;Caulley L;Chaiyakunapruk N;Greenberg D;Loder E;Mauskopf J;Mullins CD;Petrou S;Pwu RF;Staniszewska S;CHEERS 2022 ISPOR Good Research Practices Task Force
通讯作者：
CHEERS 2022 ISPOR Good Research Practices Task Force