Economic Evaluation of Medication-Assisted Substance Abuse Treatment

药物辅助药物滥用治疗的经济评估

基本信息

批准号：
9037643
负责人：
Bruce R Schackman
金额：
$ 38.67万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-04-01 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9037643
关键词：
Abstinence Adherence Admission activity Adoption Affinity Aftercare Agonist Buprenorphine Clinical Clinical Trials Clinical Trials Network Communities Cost Measures Costs and Benefits Data Data Analyses Dependence Drug Addiction Drug Metabolic Detoxication Drug Prescriptions Drug abuse Economic Policy Economics Employment Evaluation Evaluation Studies FDA approved Formulation Genetic Genetic Screening Genetic screening method Health Health Personnel Health Policy Heroin Abuse Heroin Dependence Imprisonment Individual Injectable Investments Lead Maintenance Measures Medical Methods Minority Naloxone Naltrexone Narcotic Antagonists Opiate Addiction Opioid Oral Outcome Outpatients Participant Patients Pharmaceutical Preparations Pharmacotherapy Policies Policy Maker Price Procedures Protocols documentation Provider Qualifying Quality of life Quality-Adjusted Life Years Randomized Controlled Trials Relapse Research Personnel Services Site Societies Testing Time Treatment Cost United States Visit base comparative effectiveness cost cost effectiveness dependence relapse disorder later incidence prevention drug abuser drug misuse economic cost economic evaluation economic implication economic value evidence base experience follow-up genetic variant improved innovation medication-assisted treatment methadone maintenance opioid misuse personalized medicine prescription opioid prevent randomized trial relapse patients response social social stigma substance abuse treatment treatment program

项目摘要

DESCRIPTION (provided by applicant): Detoxification is a mainstay of treatment for opioid dependence, but the majority of patients treated in this way relapse to opioid misuse leading to a costly and ineffectual cycle of readmission for repeated detoxification. NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN) has initiated a randomized trial (CTN- 0051) that will assess the comparative effectiveness of preventing opioid dependence relapse after detoxification with extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX). These two FDA-approved medication-assisted outpatient opioid dependence treatments offer promising alternatives for opioid dependence treatment in office-based medical settings, avoiding the inconvenience and stigma associated with methadone maintenance treatment, but the medications are relatively expensive and their benefits to patients and society have not been rigorously compared to their costs. We propose to conduct an economic evaluation of XR-NTX and BUP-NX using patient-specific and site-level data collected during the CTN-0051 trial. Collecting data simultaneously on both costs and outcomes in the same trial improves the internal validity of economic analyses. We will also explore potential economic implications of findings from genetic data analyses being conducted in the CTN-0051 trial. We have assembled a uniquely qualified collaborative team of economic and health policy researchers to complete these analyses. Our specific aims are to: 1) estimate and compare costs of opioid dependence treatment with XR-NTX and BUP-NX from the perspectives of the treatment provider, the payer, and the patient; 2) estimate and compare quality-adjusted life year (QALY) outcomes for opioid dependence treatment with XR-NTX and BUP-NX; 3) from a societal perspective, evaluate the incremental cost-effectiveness and cost-benefit of opioid dependence treatment with XR-NTX compared to BUP-NX (as well as the incremental cost-effectiveness of a personalized treatment selection strategy); and 4) conduct an exploratory evaluation of the potential cost-effectiveness of pre- treatment testing for genetic variants (e.g. OPRM1, OPRK1, PDYN) associated with responses to opioid dependence treatment with XR-NTX or BUP-NX. This economic evaluation study will efficiently leverage the investment currently being made in the CTN-0051 clinical trial, and will provide rigorous and policy-relevant findings to a variety of stakeholders about the cost, cost-effectiveness, and cost-benefit of delivering evidence- based medication-assisted outpatient treatment for opioid dependence. It will also advance the field by including innovative methods to consider a personalized treatment selection strategy and by exploring the cost- effectiveness of genetic screening prior to substance abuse treatment to identify patients most likely to benefit from medication-assisted treatments.

描述（由申请人提供）：排毒是阿片类药物依赖性治疗的主要手段，但是以这种方式治疗的大多数患者复发到阿片类药物滥用，导致重复排毒的再入院周期成本昂贵且无效的周期。 NIDA的国家药物滥用治疗临床试验网络（CTN）已启动了一项随机试验（CTN-0051），该试验将评估预防释放释放的可注射naltrecone（XR-NTX）和双抑癌奈尔膦酮（BUP-NX）排毒后预防阿片类药物依赖性复发的比较有效性。这两种由FDA批准的药物辅助门诊阿片类药物依赖性治疗为基于办公室的医疗环境中的阿片类药物依赖治疗提供了有希望的替代方法，避免了与美沙酮维持治疗相关的不便和污名，但是这些药物相对昂贵，与其成本相比，对患者和社会的益处却不严格。我们建议使用在CTN-0051试验期间收集的患者特异性和现场数据对XR-NTX和BUP-NX进行经济评估。同时在同一试验中同时收集数据可以提高经济分析的内部有效性。我们还将探索CTN-0051试验中正在进行的遗传数据分析中发现的潜在经济影响。我们组建了一个具有独特的经济和健康政策研究人员合作团队，以完成这些分析。我们的具体目的是：1）从治疗提供者，付款人和患者的角度来看，估计和比较阿片类药物依赖治疗与XR-NTX和BUP-NX的成本； 2）用XR-NTX和BUP-NX进行估计和比较质量调整后的生活年（QALY）结果； 3）从社会角度来看，与BUP-NX相比，评估对阿片类药物依赖治疗的增量成本效益和成本效益（以及个性化治疗选择策略的增量成本效益）； 4）对遗传治疗前治疗测试的潜在成本效益进行探索性评估变体（例如OPRM1，OPRK1，PDYN）与对阿片类药物依赖治疗的反应相关的XR-NTX或BUP-NX相关。这项经济评估研究将有效利用CTN-0051临床试验中当前进行的投资，并将为各种利益相关者提供严格且与政策相关的发现，以提供成本，成本效益和成本效益，以提供基于证据的药物辅助辅助治疗阿片类药物依赖性。它还将通过包括创新方法来考虑个性化治疗策略，并通过在药物滥用治疗前探索基因筛查的成本效益，以识别最有可能受益于药物辅助治疗的患者，从而推进该领域。