Buprenorphine–naloxone preferred over extended-release naltrexone to prevent opioid relapse
Buprenorphine–naloxone is the preferred first-line treatment for opioid use disorder compared with extended-release naltrexone when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone, suggests a study.
Buprenorphine–naloxone was preferable to extended-release naltrexone in 97 percent of bootstrap replications at 24 weeks and in 85 percent at 36 weeks on the basis of healthcare sector perspective and a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY).
Moreover, these results were similar with incremental time abstinent from opioids as an outcome and with use of the societal perspective.
Sensitivity analysis revealed that the base-case results were sensitive to the cost of the two treatment and the success of randomized treatment initiation.
The authors conducted a cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in eight US inpatient or residential treatment programmes. Adults with opioid use disorder underwent a 24-week intervention (buprenorphine–naloxone and extended-release naltrexone) with an additional 12 weeks of observation.
The authors used healthcare sector and societal perspectives. Outcome measures included incremental costs combined with incremental QALYs and incremental time abstinent from opioids.
The study was limited by relatively short follow-up for a chronic condition, substantial missing data, and absence of information on patient out-of-pocket and social service costs.