Addiction Science Made Easy: Cost of Pharmacotherapy for Opioid Use Disorder Following Inpatient Detoxification

Addressing opioid use disorder (OUD), heroin and fentanyl use, and escalating rates of overdose deaths in the United States is a top priority. The 3 FDA-approved medications for OUD (methadone, buprenorphine, and naltrexone) are the recommended first line of treatment.

Recent studies have established similar effectiveness of these medications in preventing recurrence of opioid use for up to 6 months among those who successfully begin treatment post-detoxification. 

Adoption of these medications by providers is low, however, due to concerns over staff burden, reimbursement, increased practice costs, large patient caseloads, and long-term effectiveness.

Information about the resources and associated costs of the different treatment options could help address some of those barriers. This study describes a comprehensive multi-site cost analysis of the first head-to-head randomized clinical trial in the U.S. of extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) for prevention of opioid use recurrence/relapse (NIDA Clinical Trials Network study CTN-0051).

Cost data were collected for 3 intervention phases: program start-up, inpatient detoxification, and up to 24 weeks of medication induction and management visits.

Site visits and a cost survey were conducted at the 8 participating community-based treatment programs, and study data on medication and services use were analyzed. 

Results of the analysis found:

• Mean start-up costs for each program:
  • $1071 extended-release naltrexone (XR-NTX)
  • $828 buprenorphine-naloxone (BUP-NX)
     
• Mean costs per participant:
  • $5416 for XR-NTX
    • 57% inpatient detoxification care
    • 37% medication
    • 3% provider costs (time, e.g.)
    • 3% patient costs (transportation to/from appointments, lost work time, e.g.)
       
  • $4148 for BUP-NX
    • 64% inpatient detoxification care
    • 12% medication
    • 10% provider costs 
    • 14% patient costs 
       
• Total cost per participant ranged by site:
  • XR-NTX: $2979 to $8963
  • BUP-NX: $2521 to $6486
  • Variability largely driven by differences in inpatient detoxification costs
     

Conclusions: Providing XR-NTX and BUP-NX to patients receiving inpatient detoxification generates relatively modest additional costs to the healthcare sector for induction and medication management visits. Results of this analysis also provide practical information on the types of costs incurred by providers, payers, and patients. The inclusion of patient time and travel costs expands the perspective of this analysis beyond the formal healthcare sector, where typically only the costs to providers and third-party payers are considered. From the patient’s perspective, the costs associated with medication management visits may be a barrier for some individuals considering these treatment. This information will be valuable to all stakeholders interested in expanding access to evidence-based therapies for OUD.
 

Citation: McCollister KE, et al. Cost of pharmacotherapy for opioid use disorders following inpatient detoxification. American Journal of Managed Care 2018;24(11):522-527.

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