Buprenorphine/Naloxone and Methadone Opioid Replacement Therapy: A 2-Year Follow-Up Study and Health Economic Analysis

B. Kidd, Charlotte Renwick, S. Parrott, K. Matthews, A. Baldacchino
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Abstract

Background Opioid Replacement Therapy (ORT) is the main UK treatment for opiate dependency. Both methadone and buprenorphine-based drugs are licensed for this purpose in the UK with over 25,000 people prescribed in Scotland, mostly receiving methadone. Choice of ORT agent reflects historic guidance that methadone was the ‘first line’ recommendation if both were suitable. Now, evidence suggests that both are equally effective, although concerns regarding a higher risk of methadone overdose have been raised. Many factors, including higher costs and time commitment to dispense buprenorphine-based products, however, may have affected their wider use in the UK. Clinicians require better evidence to inform their clinical decisions. This study considers a cohort of treatment-seeking opiate-dependent individuals in a single health board area in Scotland, prescribed methadone or buprenorphine/naloxone ORT, comparing 2-year retention rates with the costs of treatment delivery and health care utilization. Methods We compared 62 patients receiving buprenorphine/naloxone (as Suboxone©) with 175 receiving methadone ORT (Total N=237). The health economic component reports only those for whom a complete dataset was available (n=212). Administrative NHS data was used to assess treatment retention and costs over a two year period. Costs included those associated with ORT delivery as well as broader healthcare utilization. Results No statistically significant differences were found with respect to retention rates or healthcare costs though the Cost Effectiveness Plane (CEP) showed considerable uncertainty in these results implying that retention may be greater in the methadone group. Conclusion This study suggests that, when combining all treatment delivery and additional healthcare costs, buprenorphine/naloxone is broadly equivalent in cost effectiveness to methadone ORT when delivered in the NHS system. Retention rates over 2 years were also comparable. These data may support the view that buprenorphine/naloxone represents a cost-neutral alternative ORT to that of methadone.
丁丙诺啡/纳洛酮和美沙酮阿片类药物替代治疗:2年随访研究和健康经济分析
背景阿片类药物替代疗法(ORT)是英国治疗阿片类药物依赖的主要方法。美沙酮和丁丙诺啡这两种药物在英国都被许可用于这一目的,苏格兰有超过2.5万人服用美沙酮。ORT药物的选择反映了历史指导,即如果两种药物都适合,美沙酮是“一线”推荐。现在,有证据表明,这两种药物同样有效,尽管人们担心美沙酮过量的风险更高。然而,许多因素,包括更高的成本和分配丁丙诺啡产品的时间承诺,可能影响了丁丙诺啡在英国的广泛使用。临床医生需要更好的证据来指导他们的临床决策。本研究考虑了苏格兰单一健康委员会地区寻求治疗的阿片类依赖个体,处方美沙酮或丁丙诺啡/纳洛酮口服治疗,比较2年保留率与治疗交付和医疗保健利用的成本。方法对62例接受丁丙诺啡/纳洛酮(Suboxone)治疗的患者与175例接受美沙酮ORT治疗的患者进行比较(总N=237)。健康经济成分只报告那些有完整数据集的人(n=212)。行政NHS数据用于评估两年期间的治疗保留和费用。费用包括与口服口服治疗提供以及更广泛的医疗保健利用有关的费用。结果在保留率和医疗费用方面没有发现统计学上的显著差异,尽管成本效益平面(CEP)显示这些结果有相当大的不确定性,这意味着美沙酮组的保留率可能更高。本研究表明,当综合所有治疗交付和额外的医疗费用时,丁丙诺啡/纳洛酮在NHS系统中交付的成本效益与美沙酮ORT大致相当。2年以上的保留率也是相当的。这些数据可能支持丁丙诺啡/纳洛酮替代美沙酮替代ORT的观点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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