Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial
Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial
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DOI：
10.1016/j.drugalcdep.2017.01.016
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发表时间：
2017-05-01
影响因子：
4.2
通讯作者：
Lintzeris, Nicholas
中科院分区：
文献类型：
--
作者：
Dunlop, Adrian J.;Brown, Amanda L.;Lintzeris, Nicholas
背景：获得阿片类激动剂治疗可能与漫长的等待期有关，并带来巨大的健康和经济负担。本研究旨在确定海洛因依赖患者每周给予丁丙诺啡-纳洛酮是否比等待名单对照组在治疗12周后海洛因使用量和相关不良健康影响有更大的减少，并检验这一策略的成本-效果。方法：在澳大利亚纽卡斯尔的一家阿片类药物治疗诊所进行了一项开放标签等待名单随机对照试验。研究对象为DSM-IV-TR型海洛因依赖者(无其他物质依赖)50例。干预组(n=25)每周舌下含服丁丙诺啡洛酮(平均剂量22.7+/-5.7 mg)，并每周进行临床回顾。等待名单对照组(n=25)未接受临床干预。主要结果是在4周、8周和12周使用海洛因(自我报告，尿毒学验证)。主要成本-效果结果是每增加一次海洛因戒除日的增量成本。结果：所有随机参与者中有80%的结果数据可用。在12周内，治疗组海洛因使用平均减少19.02天/月(95%CI-22.98，-15.06，p
Background: Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy.Methods: An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n = 25) received take-home self-administered sublingual buprenorphinenaloxone weekly (mean dose, 22.7 +/- 5.7 mg) and weekly clinical review. Waitlist controls (n = 25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day.Results: Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02 days less/month (95% CI - 22.98, -15.06, p