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. 2019 Nov;134(5):921-931.
doi: 10.1097/AOG.0000000000003503.

Methadone, Buprenorphine, or Detoxification for Management of Perinatal Opioid Use Disorder: A Cost-Effectiveness Analysis

Ashish Premkumar  1 , William A Grobman, Mishka Terplan, Emily S Miller
Affiliations

Methadone, Buprenorphine, or Detoxification for Management of Perinatal Opioid Use Disorder: A Cost-Effectiveness Analysis

Ashish Premkumar et al. Obstet Gynecol. 2019 Nov.

Abstract

Objective: To estimate whether methadone, buprenorphine, or detoxification treatment is the most cost-effective approach to the management of opioid use disorder (OUD) during pregnancy.

Methods: We created a decision analytic model that compared the cost effectiveness (eg, the marginal cost of the strategy in U.S. dollars divided by the marginal effectiveness of the strategy, measured in quality-adjusted life-years [QALYs]) of initiation of methadone, buprenorphine, or detoxification in treatment of OUD during pregnancy. Probabilities, costs, and utilities were estimated from the existing literature. Incremental cost-effective ratios for each strategy were calculated, and a ratio of $100,000 per QALY was used to define cost effectiveness. One-way sensitivity analyses and a Monte Carlo probabilistic sensitivity analysis were performed.

Results: Under base assumptions, initiation of buprenorphine was more effective at a lower cost than either methadone or detoxification and thus was the dominant strategy. Buprenorphine was no longer cost effective if the cost of methadone was 8% less than the base-case estimate ($1,646/month) or if the overall costs of detoxification were 121% less than the base-case estimate for the detoxification cost multiplier, which was used to increase the values of both inpatient and outpatient management of detoxification by a factor of 2. Monte Carlo analyses revealed that buprenorphine was the cost-effective strategy in 70.5% of the simulations. Direct comparison of buprenorphine with methadone demonstrated that buprenorphine was below the incremental cost-effective ratio in 95.1% of simulations; direct comparison between buprenorphine and detoxification demonstrated that buprenorphine was below the incremental cost-effective ratio in 45% of simulations.

Conclusion: Under most circumstances, we estimate that buprenorphine is the cost-effective strategy when compared with either methadone or detoxification as treatment for OUD during pregnancy. Nonetheless, the fact that buprenorphine was not the cost-effective strategy in almost one out of three of simulations suggests that the robustness of our model may be limited and that further evaluation of the cost-effective approach to the management of OUD during pregnancy is needed.

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Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A schematic depicting the buprenorphine arm of the decision analysis, which is part of Appendix 1
FIGURE 2
FIGURE 2
A graph of the one-way sensitivity analysis of the cost multiplier of detoxification against the incremental cost-effectiveness ratio
FIGURE 3
FIGURE 3
A graph of the one-way sensitivity analysis of the monthly outpatient cost of methadone against the incremental cost-effectiveness ratio
See this image and copyright information in PMC

Comment in

References

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