Cost-effectiveness of buprenorphine–naloxone versus extended-release naltrexone to prevent opioid relapse

Sean M. Murphy, Kathryn E. McCollister, Jared A. Leff, Xuan Yang, Philip J. Jeng, Joshua D. Lee, Edward V. Nunes, Patricia Novo, John Rotrosen, Bruce R. Schackman

Research output: Contribution to journalArticlepeer-review


Background: Not enough evidence exists to compare buprenorphine–naloxone with extended-release naltrexone for treating opioid use disorder. Objective: To evaluate the cost-effectiveness of buprenorphine–naloxone versus extended-release naltrexone. Design: Cost-effectiveness analysis alongside a previously reported randomized clinical trial of 570 adults in 8 U.S. inpatient or residential treatment programs. Data Sources: Study instruments. Target Population: Adults with opioid use disorder. Time Horizon: 24-week intervention with an additional 12 weeks of observation. Perspective: Health care sector and societal. Interventions: Buprenorphine–naloxone and extended-release naltrexone. Outcome Measures: Incremental costs combined with incremental quality-adjusted life-years (QALYs) and incremental time abstinent from opioids. Results of Base-Case Analysis: Use of the health care sector perspective and a willingness-to-pay threshold of $100 000 per QALY showed buprenorphine–naloxone to be preferable to extended-release naltrexone in 97% of bootstrap replications at 24 weeks and in 85% at 36 weeks. Similar results were obtained with incremental time abstinent from opioids as an outcome and with use of the societal perspective. Results of Sensitivity Analysis: The base-case results were sensitive to the cost of the 2 treatments and the success of randomized treatment initiation. Limitation: Relatively short follow-up for a chronic condition, substantial missing data, no information on patient out-of-pocket and social service costs. Conclusion: Buprenorphine–naloxone is preferred to extended-release naltrexone as first-line treatment when both options are clinically appropriate and patients require detoxification before initiating extended-release naltrexone.

Original languageEnglish (US)
Pages (from-to)90-98
Number of pages9
JournalAnnals of internal medicine
Issue number2
StatePublished - Jan 15 2019

ASJC Scopus subject areas

  • Internal Medicine


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