Economic Evaluation of Medication-Assisted Substance Abuse Treatment

描述（由申请人提供）：解毒是阿片类药物依赖的主要治疗方法，但大多数以这种方式治疗的患者会再次滥用阿片类药物，导致重复解毒的再入院周期昂贵且无效。NIDA的国家药物滥用治疗临床试验网络（CTN）启动了一项随机试验（CTN- 0051），该试验将评估缓释注射纳曲酮（XR-NTX）和丁丙诺啡-纳洛酮（BUP-NX）戒毒后预防阿片类药物依赖复发的比较有效性。这两种fda批准的药物辅助门诊阿片类药物依赖治疗为办公室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案，避免了与美沙酮维持治疗相关的不便和耻辱，但药物相对昂贵，其对患者和社会的益处尚未与成本进行严格比较。我们建议使用CTN-0051试验期间收集的患者特异性和部位水平数据对XR-NTX和BUP-NX进行经济评估。在同一试验中同时收集成本和结果的数据可以提高经济分析的内部有效性。我们还将探讨CTN-0051试验中基因数据分析结果的潜在经济意义。我们已经组建了一个由经济和卫生政策研究人员组成的独特合格的合作团队来完成这些分析。我们的具体目标是：1)从治疗提供者、付款人和患者的角度估计和比较XR-NTX和BUP-NX治疗阿片类药物依赖的成本；2)评估并比较XR-NTX和BUP-NX治疗阿片类药物依赖的质量调整生命年（QALY）结果；3)从社会角度，评估XR-NTX与BUP-NX相比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)对基因预处理检测的潜在成本效益进行探索性评估

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.