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. 2023 Sep 5;6(9):e2329583.
doi: 10.1001/jamanetworkopen.2023.29583.

Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder

Juliet M Flam-Ross  1   2 , Elizabeth Marsh  1 , Michelle Weitz  1 , Alexandra Savinkina  3 , Bruce R Schackman  4 , Jianing Wang  1 , R W M A Madushani  1 , Jake R Morgan  5 , Joshua A Barocas  6 , Alexander Y Walley  7 , Stavroula A Chrysanthopoulou  8 , Benjamin P Linas  1   9   5 , Sabrina A Assoumou  1   9
Affiliations

Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder

Juliet M Flam-Ross et al. JAMA Netw Open. .

Abstract

Importance: In 2017, the US Food and Drug Administration (FDA) approved a monthly injectable form of buprenorphine, extended-release buprenorphine; published data show that extended-release buprenorphine is effective compared with no treatment, but its current cost is higher and current retention is lower than that of transmucosal buprenorphine. Preliminary research suggests that extended-release buprenorphine may be an important addition to treatment options, but the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine remains unclear.

Objective: To evaluate the cost-effectiveness of extended-release buprenorphine compared with transmucosal buprenorphine.

Design, setting, and participants: This economic evaluation used a state transition model starting in 2019 to simulate the lifetime of a closed cohort of individuals with OUD presenting for evaluation for opioid agonist treatment with buprenorphine. The data sources used to estimate model parameters included cohort studies, clinical trials, and administrative data. The model relied on pharmaceutical costs from the Federal Supply Schedule and health care utilization costs from published studies. Data were analyzed from September 2021 to January 2023.

Interventions: No treatment, treatment with transmucosal buprenorphine, or treatment with extended-release buprenorphine.

Main outcomes and measures: Mean lifetime costs per person, discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).

Results: The simulated cohort included 100 000 patients with OUD receiving (61% male; mean [SD] age, 38 [11] years) or not receiving medication treatment (58% male, mean [SD] age, 48 [18] years). Compared with no medication treatment, treatment with transmucosal buprenorphine yielded an ICER of $19 740 per QALY. Compared with treatment with transmucosal buprenorphine, treatment with extended-release buprenorphine yielded lower effectiveness by 0.03 QALYs per person at higher cost, suggesting that treatment with extended-release buprenorphine was dominated and not preferred. In probabilistic sensitivity analyses, treatment with transmucosal buprenorphine was the preferred strategy 60% of the time. Treatment with extended-release buprenorphine was cost-effective compared with treatment with transmucosal buprenorphine at a $100 000 per QALY willingness-to-pay threshold only after substantial changes in key parameters.

Conclusions and relevance: In this economic evaluation of extended-release buprenorphine compared with transmucosal buprenorphine for the treatment of OUD, extended-release buprenorphine was not associated with efficient allocation of limited resources when transmucosal buprenorphine was available. Future initiatives should aim to improve retention rates or decrease costs associated with extended-release buprenorphine.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Walley reported grants from the National Institutes of Health (principal and co-investigator on multiple studies during the conduct of the study); personal fees from Massachusetts Department of Public Health (contract for salary support for Medical Director, Bureau of Substance Addiction Services), grants from Centers for Disease Control and Prevention (principal investigator), personal fees from American Academy of Addiction Psychiatry, Provider Clinical Support Services (REACH mentor, honorarium for overdose prevention webinar), personal fees from American Academy of Addiction Psychiatry, Opioid Response Network (honorarium for naloxone saturation webinar), personal fees from American Society of Addiction Medicine (honorarium for overdose prevention education webinar, and personal fees from John Snow Inc (contract for content expertise on HIV and OUD; podcast production) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. One-Way Sensitivity Analysis of Retention on Medications for Opioid Use Disorder
The figure shows the cost-effectiveness of treatment with transmucosal buprenorphine and treatment with extended-release buprenorphine strategies as the 6-month rate of retention is increased. The dotted line at the incremental cost-effectiveness ratio (ICER) of $100 000 represents a threshold of $100 000 per quality-adjusted life years (QALY) willingness-to-pay and the dotted line at $0 represents the lowest value at which any strategy is not dominated. Any dots shown between the 2 sets of dotted lines are considered to be cost-effective strategies.
Figure 2.
Figure 2.. Two-Way Deterministic Sensitivity Analysis of Pharmaceutical Cost and Retention for Extended-Release Buprenorphine Cost-Effectiveness Plot
This figure represents the cost-effective strategy at a $100 000 per quality-adjusted life years (QALY) willingness-to-pay threshold when we vary both retention and cost for extended-release buprenorphine at the same time in increments of 5%. The values in the upper right side of the figure, where the dots turn to darkest, are combinations of retention increases and cost reductions resulting in the treatment with extended-release buprenorphine strategy no longer being dominated.
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