OBJECTIVES: Of the five most-populous countries in Western Europe, the United Kingdom (UK) has the highest rate of problematic opioid abuse and among the highest rates of prescription opioid abuse. There has never been more urgency to treat opioid use disorder (OUD) given its burden on public health and local resources, yet conventional orally-administered maintenance treatments like sublingual buprenorphine/naloxone (SL-BPN) have several limitations owing to high rates of prescription drug misuse and diversion and hence sub-optimal effectiveness. Investigational CAM2038 (a flexible-dose depot buprenorphine injection) has emerged from this need and demonstrated superiority on the cumulative density function of negative urine samples versus SL-BPN in a 24-week Phase 3 clinical trial of substitution therapy for opioid-dependent patients. This analysis assessed its potential economic impact in the UK.

METHODS: Direct medical and societal costs (excluding OUD drug costs) were assessed over 52 weeks using a 5-state Markov model wherein cohorts received either CAM2038 or SL-BPN. On-treatment transition probabilities were derived from the Phase 3 trial. State-specific event and other transition probabilities and associated costs were literature-based. Uncertainty was evaluated with scenario and probabilistic sensitivity analysis. No discounting was applied due to the short time-horizon.

RESULTS: CAM2038 accrued lower annual total per-patient costs (-£4382). Cost-savings were primarily attributable to lower crime-related costs (-£3281); of which 85% were attributable to lower crime-anticipation/avoidance and victimization (-£2779). Direct-medical cost-savings (-£777) were primarily attributable reduced utilization of supervised self-administration (-£361) and prescription/controlled drug fees (-£311). Savings attributable to avoided HIV/HCV infections (-£43) were modest assuming traditional interferon-based HCV treatment, but were more-pronounced assuming treatment with protease inhibitors (-£885).

CONCLUSIONS: In the UK, CAM2038 is potentially a pharmacoeconomically preferable alternative to SL-BPN for OUD, with direct-medical and societal cost-savings estimated over 52 weeks.