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Cost-Effectiveness and Benefits to Quality of Life of XR-NTX vs BUP-NX for the Treatment of Opioid Use Disorder

December 1, 2021
Meg Brunner, MLIS
Murphy SM, et al. Economic evaluation of extended-release injectable naltrexone compared to buprenorphine-naloxone initiated in inpatient settings for treatment of opioid use disorder: Results derived from the X:BOT clinical trial. CHERISH factsheet, May 2021. Free online,
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December 2021
CTN Dissemination Library


The CTN X:BOT trial compared the effectiveness of extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) for preventing a return to opioid use. 
Researchers found that it was more difficult to start patients on XR-NTX than BUP-NX, which negatively affected overall relapse outcomes, but that both medications were equally safe and effective for those who did successfully begin treatment.

Cost Benefit Drawing

Investigators and colleagues associated with the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV,

and HIV (CHERISH) wanted to find out what the costs, health-related quality-of-life changes, and cost-effectiveness of OUD treatment with XR-NTX compared to BUP-NX were. They also wanted to find out if there was any cost benefit to making it easier to start patients on XR-NTX (compared to BUP-NX). This two-page factsheet summarizes the results of that investigation. 
The CHERISH team found that, for treatment providers, offering XR-NTX and/or BUP-NX as part of existing detoxification treatment only modestly increased costs ā€“ adding about $800 (BUP-NX) to $1000 (XR-NTX) in start-up costs.

They also found that medications for OUD can improve health-related quality of life (HRQoL) for most individuals. 

Additionally, analysis revealed that when XR-NTX and BUP-NX are equally clinically appropriate and patients face potential detoxification hurdles with starting XR-NTX, BUP-NX should be considered the preferred first-line treatment for OUD. 

The factsheet also includes several recommendations based on their investigation:

  1. Policymakers who want to maximize economic value should consider promoting BUP-NX over XR-NTX in contexts where both medications are shown to be equally effective and appropriate.
  2. Providers should help connect patients to services that address their socioeconomic and psychosocial needs in addition to their health needs, customizing their care to better improve their quality of life.
  3. Healthcare systems should invest in models of care that increase the likelihood of successful initiation of medication treatment for OUD, especially for XR-NTX, and minimize the duration of detoxification and residential delays.