COMPARING THECOSTEFFECTIVENESS OFONSITEBUPRENORPHINE TREATMENT VERSUSTREATMENT FACILITY REFERRALATHARM REDUCTION AGENCIES
Author(s)
Jessica Kim, MS1, Caroline Andy, MS2, Danielle Ryan, MS1, Sean Murphy, PhD1.
1Population Health Sciences, Weill Cornell Medicine, New York, NY, USA, 2Weill Cornell Medicine, New York, NY, USA.
1Population Health Sciences, Weill Cornell Medicine, New York, NY, USA, 2Weill Cornell Medicine, New York, NY, USA.
OBJECTIVES: While the current standard of care (SoC) for the treatment of opioid use disorder (OUD) is referral to treatment facilities, buprenorphine - an effective medication for OUD - can be initiated in diverse settings. A recent clinical trial evaluated the effectiveness of a low-threshold buprenorphine intervention offering onsite buprenorphine maintenance treatment (O-BMT) at harm reduction agencies, compared to SoC. Given the limited resources available to such facilities and the substantial personal and public burden associated with inadequately treated OUD, it is critical to consider the intervention costs alongside downstream cost offsets and effectiveness.
METHODS: A prospective cost-effectiveness analysis was conducted alongside the aforementioned trial. The cost measure was the total healthcare utilization expenditure associated with Medicare. The effectiveness measure was the number of opioid-free weeks over the 12-week study period. Covariate adjusted mean costs and effectiveness were estimated. The incremental cost-effectiveness ratio (ICER) was calculated as the between-arm difference in mean cost divided by mean effectiveness. Nonparametric bootstrapping was performed on the presented estimates. Cost effectiveness probability at willingness-to-pay thresholds was evaluated using a cost effectiveness acceptability curve.
RESULTS: O-BMT significantly lowered mean healthcare utilization cost by an estimated $7,933 (95% CI: -17,999, -2,631). O-BMT patients gained an estimated average of 0.97 opioid-free weeks compared to SoC (0.95% CI: -0.84, 2.52). O-BMT treatment reduced average cost by $6,092 for every opioid-free week gained (ICER 95% CI: -94,784, -29,060). O-BMT was cost effective at a willingness-to-pay threshold of $12,075/opioid-free week in 95% of estimates.
CONCLUSIONS: O-BMT reduced healthcare expenditures and improved patient outcomes in a majority of scenarios, demonstrating a favorable intervention from a health economic perspective. These findings support buprenorphine’s utility integrated into community care models. Additional research is needed to determine whether O-BMT significantly improves opioid abstinence over longer periods.
METHODS: A prospective cost-effectiveness analysis was conducted alongside the aforementioned trial. The cost measure was the total healthcare utilization expenditure associated with Medicare. The effectiveness measure was the number of opioid-free weeks over the 12-week study period. Covariate adjusted mean costs and effectiveness were estimated. The incremental cost-effectiveness ratio (ICER) was calculated as the between-arm difference in mean cost divided by mean effectiveness. Nonparametric bootstrapping was performed on the presented estimates. Cost effectiveness probability at willingness-to-pay thresholds was evaluated using a cost effectiveness acceptability curve.
RESULTS: O-BMT significantly lowered mean healthcare utilization cost by an estimated $7,933 (95% CI: -17,999, -2,631). O-BMT patients gained an estimated average of 0.97 opioid-free weeks compared to SoC (0.95% CI: -0.84, 2.52). O-BMT treatment reduced average cost by $6,092 for every opioid-free week gained (ICER 95% CI: -94,784, -29,060). O-BMT was cost effective at a willingness-to-pay threshold of $12,075/opioid-free week in 95% of estimates.
CONCLUSIONS: O-BMT reduced healthcare expenditures and improved patient outcomes in a majority of scenarios, demonstrating a favorable intervention from a health economic perspective. These findings support buprenorphine’s utility integrated into community care models. Additional research is needed to determine whether O-BMT significantly improves opioid abstinence over longer periods.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE446
Topic
Economic Evaluation