Cost-effective treatment for adolescents with opioid dependence
- Presenter:
Chair: William S. Cartwright; Discussant: Kathryn McCollister Mon June 5, 2006 13:45-15:15 Room 326
Optimal treatment strategies for drug dependence is rarely based on analysis of economic outcomes, yet limited financial resources for treatment frequently inhibit greater access to treatment services. A clinical trial in the National Drug Abuse Treatment Clinical Trials Network (CTN) is testing the effectiveness of Buprenorphine/Naloxone-facilitated rehabilitation (Bup/Nal) in opioid dependent adolescents/young adults. Bup/Nal in combination with psychosocial treatment has already been shown to improve treatment outcomes in adults. This new combined therapy offers hope for opiate dependent young people who have been growing in number and have very few prospects for treatment or recovery. Yet the tradeoff between short-term treatment and maintenance is acutely felt by young adults who may obtain better outcomes from maintenance therapy, but face the high costs of a lifetime of maintenance. If economic analyses with relevant and useful outcome measures could be performed on these treatment alternatives, a preferred treatment strategy for these patients could be ascertained. We are conducting a cost-effectiveness analysis to compare the incremental economic outcomes between short term Buprenorphine/Naloxone treatment and maintenance for treating opioid dependence in adolescents and young adults. The EuroQol EQ5D will be used to assess the patient’s preference for their health state. Urine analysis will determine whether subject is drug free at 3, 6, 9, and 12 months. The incremental medical costs (including both substance abuse treatment costs, the costs of other medical therapies, and costs of medical care born by patients) associated with the BUP/NAL intervention will be estimated. The analysis will estimate cost-effectiveness ratios (CER) which will represent the incremental medical costs of BUP/NAL per drugfree addict and per QALY; and estimate net social benefits of BUP/NAL by estimating the value to society of a drug-free addict in terms of reduced morbidity, crime, and improved productivity net of medical costs. Data collection within the clinical trial will involve the integration of instruments to collect counts of medical service use both within and outside the study protocol. A modified client-DATCAP will be used to determine price weights as proxies for social costs to value these medical services. The clinical trial is ongoing but a preliminary cost effectiveness analysis at three months postrandomization will be completed on the first 140 subjects by June 2006.
