One key strategy in reducing deaths from the opioid epidemic is to improve access to existing evidence-based treatments. Two new economic studies by CHERISH Investigators Drs. Sean Murphy, Kathryn McCollister, and Bruce Schackman can help providers, patients, and payers sort through alternative pharmacotherapies to prevent opioid relapse.
The US Food and Drug Administration has approved two medications for the treatment of opioid use disorder that can be prescribed by clinicians in an office-based setting: naltrexone, which is typically administered as an extended release injection (XR-NTX), and buprenorphine, which is often combined with naloxone (BUP-NX). The National Institute on Drug Abuse supported a clinical trial to assess the comparative effectiveness of initiating XR-NTX and BUP-NX in inpatient and residential treatment programs and continuing treatment in an outpatient setting. The clinical trial results published in the Lancet in January 2018, showed it is more difficult to initiate patients on XR-NTX than BUP-NX in this population, and this negatively affected overall relapse outcomes. However, once initiated, both medications were equally safe and effective.
In a new cost-effectiveness analysis published in the Annals of Internal Medicine on December 18, 2018, Dr. Murphy and colleagues found BUP-NX was preferred to XR-NTX as the first line of treatment from the healthcare sector and societal perspectives, due to the similarity in effectiveness between the therapies and the higher cost of the XR-NTX treatment strategy. The higher cost of the XR-NTX treatment strategy was driven largely by higher medication costs and the longer detoxification period required before starting treatment with XR-NTX. This higher cost was not associated with significantly better outcomes measured in QALYs or abstinent years gained; thus, a reduction in the cost of the XR-NTX injection and less costly modes of treatment initiation would likely improve its relative economic value.