Estimating the Potential Cost-Effectiveness of Long-Acting Naltrexone versus Oral Naltrexone for Alcohol Use Disorder
Author(s)
Thomas Hopkins, MS, PharmD1, Lou P. Garrison, PhD2;
1CHOICE Institute, University of Washington, Seattle, WA, USA, 2University of Washington, CHOICE Institute, Seattle, WA, USA
1CHOICE Institute, University of Washington, Seattle, WA, USA, 2University of Washington, CHOICE Institute, Seattle, WA, USA
Presentation Documents
OBJECTIVES: Nearly 1 in 10 Americans have alcohol use disorder (AUD)—a debilitating disease with annually nearly 200,000 deaths and costs over $300 billion, but with less than 2% of these patients receiving pharmacotherapy. This analysis estimates the potential cost-effectiveness of long-acting naltrexone (LAI-NTX) to oral naltrexone (PO-NTX) for the treatment of AUD.
METHODS: From a US payer perspective, this modelling analysis compared LAI-NTX versus PO-NTX for AUD, using a Markov model with monthly cycles and five health states: remission, long-term remission, heavy drinking, alcoholic liver disease, and death.For the typical case of 21-year-old AUC patient initiating treatment, followed for a lifetime, the clinical parameter inputs were based on published trial data. Direct medical costs (in 2024$) and outcome (quality-adjusted life-years--QALYs) were discounted at 3%. A willingness-to-pay (WTP) per QALY range ($100K-$150K) was used. To address uncertainty, one-way sensitivity analyses, probabilistic sensitivity analyses, and scenario analyses with different time horizons were performed.
RESULTS: The estimated discounted lifetime direct costs of LAI-NTX and PO-NTX were $256,368 and $7,684, respectively. The total discounted lifetime QALYs for LAI-NTX and PO-NTX were 17.96 and 18.01, respectively. LAI-NTX was dominated. Sensitivity analyses did not alter this conclusion.
CONCLUSIONS: Similar to the results of the Institute for Clinical and Economic Review (2018) for LAI-NTX compared to the oral formulation for opioid use disorder, injectable long-acting naltrexone treatment is projected to cost much more, and, on average, have no positive health benefit. However, its continued use with substantial annual sales (>$400 million), the poor uptake of PO-NTX, and possible heterogeneity of treatment effect suggest the need for further long-term real-world study, assessing as well broader societal impact on productivity losses and family spillovers. Importantly, further research is warranted to address these shortcomings before recommending against all access to this high-cost treatment for costly AUD.
METHODS: From a US payer perspective, this modelling analysis compared LAI-NTX versus PO-NTX for AUD, using a Markov model with monthly cycles and five health states: remission, long-term remission, heavy drinking, alcoholic liver disease, and death.For the typical case of 21-year-old AUC patient initiating treatment, followed for a lifetime, the clinical parameter inputs were based on published trial data. Direct medical costs (in 2024$) and outcome (quality-adjusted life-years--QALYs) were discounted at 3%. A willingness-to-pay (WTP) per QALY range ($100K-$150K) was used. To address uncertainty, one-way sensitivity analyses, probabilistic sensitivity analyses, and scenario analyses with different time horizons were performed.
RESULTS: The estimated discounted lifetime direct costs of LAI-NTX and PO-NTX were $256,368 and $7,684, respectively. The total discounted lifetime QALYs for LAI-NTX and PO-NTX were 17.96 and 18.01, respectively. LAI-NTX was dominated. Sensitivity analyses did not alter this conclusion.
CONCLUSIONS: Similar to the results of the Institute for Clinical and Economic Review (2018) for LAI-NTX compared to the oral formulation for opioid use disorder, injectable long-acting naltrexone treatment is projected to cost much more, and, on average, have no positive health benefit. However, its continued use with substantial annual sales (>$400 million), the poor uptake of PO-NTX, and possible heterogeneity of treatment effect suggest the need for further long-term real-world study, assessing as well broader societal impact on productivity losses and family spillovers. Importantly, further research is warranted to address these shortcomings before recommending against all access to this high-cost treatment for costly AUD.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE411
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Mental Health (including addition)