COST-EFFECTIVENESS ANALYSIS OF OPIOID SUBSTITUTION TREATMENT IN REPUBLIC OF SOUTH AFRICA
Author(s)
Hren R1, Milanic M2
1Institute of Mathematics, Physics and Mechanics, Ljubljana, Slovenia, 2University of Ljubljana, Ljubljana, Slovenia
OBJECTIVES: The primary goal of our study was to comprehensively compare cost-effectiveness of both treatment options for pharmacologic opioid substitution therapy (methadone vs. buprenorphine/naloxone combination) available in Republic of South Africa (RSA) and treatment modalities used in the clinical practice (maintenance vs. detoxification). In our study, we have thus systematically compared: (i) cost-effectiveness of maintenance treatment with methadone and buprenorphine/naloxone combination, (ii) cost-effectiveness of detoxification and maintenance treatment with buprenorphine/naloxone combination, and (iii) cost-effectiveness of detoxification treatment with methadone and maintenance treatment with buprenorphine/naloxone combination. METHODS: We have adapted a micro-simulation decision model to the real-life conditions in RSA using locally-specific data for treatment costs of methadone and buprenorphine/naloxone combination with the average dose of treatment set at 20 mg/day and 2 mg/day, respectively (base case scenario). Direct costs of detoxification consisted of the costs of a 14-day in-patient stay, while direct costs of maintenance treatment were based on COBRA (Cost-Benefit and Risk Appraisal of Substitution Treatment in Routine) study and adjusted to conditions of the local jurisdiction. To ensure that costs are estimated conservatively, no indirect costs were considered in the base case scenario. RESULTS: Our model has shown that under base case scenario maintenance treatment with buprenorphine/naloxone dominated all other treatment strategies: (i) maintenance treatment with methadone by saving 8,025 ZAR and gaining 0.1534 QALY per patient per year, (ii) detoxification with buprenorphine/naloxone by saving 31,627 ZAR and gaining 0.1475 QALY per patient per year, and (iii) detoxification with methadone by saving 31,584 ZAR and gaining 0.1534 QALY per patient per year. Both deterministic and probabilistic sensitivity analysis based on modifying parameters in the model confirmed robustness of our findings. CONCLUSIONS: Results of our study indicate that in RSA maintenance treatment with buprenorphine/naloxone combination is superior, i.e., cost-saving, when compared to any other currently available substitution treatment strategy.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PMH16
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Mental Health