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Daily medication more cost-effective than monthly injections to prevent opioid relapse

A daily dose of buprenorphine-naloxone is significantly less costly than monthly injections of extended-release naltrexone for treating opioid use disorder, according to findings published in Annals of Internal Medicine.

Three medications — methadone, buprenorphine and naltrexone — are FDA approved for opioid use disorder, according to Sean M. Murphy, PhD, associate professor of research in health care policy and research at Weill Cornell Medical College, and colleagues wrote.

However, “evidence regarding the economic value of these treatments, particularly evidence from clinical trials, is limited,” they wrote.

Murphy and colleagues conducted an analysis of a previous randomized clinical trial to compare the cost-effectiveness of daily oral buprenorphine-naloxone vs. monthly extended-release naltrexone injections.

The trial included 570 adults with opioid use disorder (average age, 34 years; 70% men; 74% white) who were randomly assigned to receive buprenorphine-naloxone (n = 287) or extended-release naltrexone (n = 283) for 24 weeks. Participants were observed for an additional 12 weeks.

The researchers measured incremental costs combined with incremental quality-adjusted life-years and incremental time abstinent from opioids.

Generic buprenorphine-naloxone tablets cost $1.20 per 4 mg and $2.17 per 8 mg, while extended-release naltrexone injections cost $704, according to the Federal Supply Schedule.

Overall, the total cost for extended-release naltrexone injections was $5,317 (95% CI, 1,162-9,472) higher than buprenorphine-naloxone. The driving factors for the significantly higher relative cost for extended-release naltrexone were its higher unit price and the additional costs associated with the detoxification requirement.

Between the medications, there were no statistically significant differences associated with criminal activity, reduced workplace productivity, patient time and effectiveness.

“Data from this clinical trial indicate that buprenorphine-naloxone is typically preferred as a first-line treatment when both options are clinically appropriate and patients require detoxification to initiate extended-release naltrexone therapy,” Murphy and colleagues concluded.

In an accompanying editorial, Joshua A. Barocas, MD, and Richard Saitz, MD, MPH, both from Boston University School of Public Health, wrote that the study by Murphy and colleagues demonstrates that physicians need to be explicit about the factors that influence decisions.

“We should evaluate treatment for opioid addiction as we do for other chronic medical diseases, by assessing efficacy, costs, risks and the likelihood of success, and not on the basis of beliefs, which partly underlie regulations that restrict access,” they wrote. “Like treatment for many other chronic disorders, opioid use disorder treatment comes in many forms and is often lifelong. Basing medical decisions on beliefs about medications does nothing to help the growing pool of those with opioid use disorder, who if untreated are likely to fall victim to an overdose.” – by Alaina Tedesco

Disclosures: Murphy reports receiving grants from NIH. Please see study for all other authors’ relevant financial disclosures. Please see editorial for complete list of Barocas and Saitz’s relevant financial disclosures.