A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment. for heroin dependence in a primary care setting
A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment. for heroin dependence in a primary care setting
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DOI：
10.2165/00019053-200523010-00007
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发表时间：
2005-01-01
影响因子：
4.4
通讯作者：
Ritter, AJ
中科院分区：
文献类型：
--
作者：
Harris, AH;Gospodarevskaya, E;Ritter, AJ
背景和目的：丁丙诺啡在治疗海洛因依赖方面提供了美沙酮的替代品，并且具有允许隔日给药的优点。本研究首次使用随机试验中收集的经济和临床数据来检验丁丙诺啡作为初级保健环境中海洛因依赖维持治疗的成本效益。 研究设计和方法：该研究是一项随机、开放标签、为期 12 个月的试验，受试者为社区环境中的 139 名海洛因依赖患者，接受丁丙诺啡或美沙酮个体化治疗方案。目前正在接受美沙酮计划的患者（n = 57；继续治疗亚组）与新治疗接受者（n = 82；初始治疗亚组）分开进行分析。该研究采取了广泛的社会视角，包括健康、犯罪和个人成本。有关资源使用和结果的数据是临床记录和访谈自我报告的结合。主要结果是不使用海洛因的每额外一天和每个 QALY 的增量成本。对不确定性的分析计算了一系列可接受的结果货币价值的净收益的可能性。所有费用均以 1999 澳元 ($A) 为单位。 结果：在试验一年中，随机接受美沙酮 (225 [95% CI 91, 266]) 或丁丙诺啡 (222 [95% CI 194, 250]) 组的患者之间估计的平均戒除海洛因天数没有显着差异。丁丙诺啡与 52 周内平均 QALY 提高 0.03 相关（不显着）。美沙酮的总费用为 $A17 736 (95% CI-$A2981, $A38 364)，丁丙诺啡的总费用为 $A11 916 (95% CI - $A7697, $A16 135)；不包括犯罪的费用分别为 $A4513（95% CI $A3495、$A5531）和 $A5651（95% CI $A4202、$A7100）。由于增加了无海洛因天数，并且犯罪成本包括丁丙诺啡，其成本较低，但无海洛因天数较少。如果排除犯罪成本，丁丙诺啡的成本比美沙酮更高，但结果更差。以额外的 QALY 作为结果，如果排除犯罪，丁丙诺啡的成本效益为 A39 404 美元，但如果包括犯罪，则丁丙诺啡占主导地位。结论：试验发现，在这一特定环境中，美沙酮和丁丙诺啡维持治疗的成本或结果没有显着差异。虽然有一些。的结果表明美沙酮可能具有成本优势，但很难从试验数据推断提供丁丙诺啡作为替代品会对总成本或结果产生重大影响。成本和结果的点估计表明丁丙诺啡可能对那些开始治疗的人有优势。然而，置信区间很宽，用一种治疗方法替代另一种治疗方法获得净效益的可能性接近 50%。
Background and aim: Buprenorphine offers an alternative to methadone in the treatment of heroin dependence, and has the advantage of allowing alternate-day dosing. This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a randomised trial.Study design and methods: The study was a randomised, open-label, 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone. Those who were currently on a methadone program (n = 57; continuing therapy subgroup) were analysed separately from new treatment recipients (n = 82; initial therapy subgroup). The study took a broad societal perspective and included health, crime and personal costs. Data on resource use and outcomes were a combination of clinical records and self report at interview. The main outcomes were incremental cost per additional day free of heroin use and per QALY. An analysis of uncertainty calculated the likelihood of net benefits for a range of acceptable money values of outcomes. All costs were in 1999 Australian dollars ($A).Results: The estimated mean number of heroin-free days did not differ significantly between those randomised to methadone (225 [95% CI 91, 266]), or buprenorphine (222 [95% Cl 194, 250]) over the year of the trial. Buprenorphine was associated with an average 0.03 greater QALYs over 52 weeks (not significant). The total cost was $A17 736 (95% CI-$A2981, $A38 364) with methadone and $A11 916 (95% CI $A7697, $A16 135) with buprenorphine; costs excluding crime were $A4513 (95% CI $A3495, $A5531) and $A5651 (95% CI $A4202, $A7100). With additional heroin-free days as the outcome, and crime costs included buprenorphine has a lower cost but less heroin-free days. If crime costs are excluded buprenorphine has a higher cost and worse outcome than methadone. With additional QALYs as the outcome, the cost effectiveness of buprenorphine is $A39 404 if crime is excluded, but buprenorphine is dominant if crime is included.Conclusions: The trial found no significant differences in costs or outcomes between methadone and buprenorphine maintenance in this particular setting. Although some. of the results suggest that methadone may have a cost advantage, it is difficult to infer from the trial data that offering buprenorphine as an alternative would have a significant effect on total costs or outcomes. The point estimates of costs and outcomes suggest that buprenorphine may have an advantage in those initiating therapy. The confidence intervals were wide, however, and the likelihood of net benefits from substituting one treatment for another was close to 50%.