Weighing the Costs and Benefits of Initiating Extended-release Injectable Naltrexone Compared to Buprenorphine-naloxone

Naltrexone and buprenorphine are two effective medications for opioid use disorder (OUD). Naltrexone, which is typically given as a monthly extended-release injection (XR-NTX), and daily oral buprenorphine, which is typically combined with naloxone (BUP-NX), are prescribed in outpatient or office-based medical settings. XR-NTX patients, however, need to complete detoxification before starting treatment.

Results from a national clinical trial, X:BOT, published in January 2018, showed it was more difficult to initiate patients in inpatient and residential settings on XR-NTX than BUP-NX. Both medications were found to be equally safe and effective for those who successfully initiated treatment.

Investigators and colleagues associated with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) conducted primary and secondary economic analyses using data collected from the X:BOT trial. They measured the cost, quality of life impact, and cost-effectiveness of initiating XR-NTX and BUP-NX in inpatient and residential treatment programs.

The following fact sheet summarizes key economic implications of each treatment and offers recommendations for policymakers, providers, and healthcare systems to effectively deliver XR-NTX and BUP-NX.