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Hospital-initiated buprenorphine treatment more cost-effective
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Buprenorphine treatment initiated in the ED was more cost-effective than referral to community-based treatment or combined brief intervention and referral, according to recent findings.
“In a recent clinical trial [ED] patients with a DSM-IV diagnosis of opioid dependence were randomized to one of three treatment groups: brief intervention combined with ED-initiated buprenorphine–naloxone and ongoing primary care-based buprenorphine–naloxone; brief intervention along with referral to community-based treatment; and referral alone,” Susan H. Busch, PhD, of Yale School of Public Health, and colleagues wrote. “The group receiving ED-initiated buprenorphine–naloxone had improved outcomes compared to the other two treatments studied. However, ED-initiated buprenorphine has yet to become common practice in the ED.”
To evaluate the cost-effectiveness of these three methods, researchers used self-reported 30-day assessment data among opioid-dependent adults to establish cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and illicit opioid-free days in the past week.
Analysis of only health care system costs indicated ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral at all positive willingness-to-pay values.
For a willingness-to-pay threshold of $1,000 for 30-day treatment engagement, researchers were 79% certain ED-initiated buprenorphine treatment was most cost-effective, compared with brief intervention and referral.
Similar associations were found for the number of days free from illicit opioid use in the last week.
Secondary analyses that included individuals with missing cost data, crime and patient time costs in the numerator, and changes in unit price estimates indicated robust findings.
“We were excited to learn that not only was ED-initiated buprenorphine more effective in engaging patients in treatment, but it was cost-effective,” study researcher Gail D'Onofrio, MD, of Yale School of Public Health, said in a press release. “All insurance payers and health care systems should be interested in these results.” – by Amanda Oldt
Disclosure: Busch reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.