Titre : | The cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States |
Titre traduit : | (Le rapport coût-efficacité du traitement de maintenance à la buprénorphine dans la dépendance aux opiacés, aux Etats-Unis.) |
Auteurs : | P. G. BARNETT ; G. S. ZARIC ; BRANDEAU M. L. |
Type de document : | Périodique |
Année de publication : | 2001 |
Format : | 1267-1278 / tabl. |
Note générale : |
Addiction, 2001, 96, (9), 1267-1278 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés TRAITEMENT DE MAINTENANCE ; BUPRENORPHINE ; COUT ; EFFICACITE ; QUALITE DE VIE ; VIH ; MODELEThésaurus géographique ETATS-UNIS |
Résumé : |
ENGLISH : Aims. To determine the cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States, particularly its effect on the HIV epidemic. Design. We developed a dynamic model to capture the effects of adding buprenorphine maintenance to the current opiate dependence treatment system. We evaluated incremental costs, including all health-care costs, and incremental effectiveness, measured as quality-adjusted life years (QALYs) of survival. We considered communities with HIV prevalence among injection drug users of 5% and 40%. Because no price has been set in the United States for a dose of buprenorphine, we considered three prices per dose : $5, $15, and $30. Findings. If buprenorphine increases the number of individuals in maintenance treatment by 10%, but does not affect the number of individuals receiving methadone maintenance, the cost-effectiveness ratios for buprenorphine maintenance therapy are less than $45 000 per QALY gained for all prices, in both the low-prevalence and high-prevalence communities. If the same number of individuals enter buprenorphine maintenance (10% of the number currently in methadone), but half are injection drug users newly entering maintenance and half are individuals who switched from methadone to buprenorphine, the cost-effectiveness ratios in both communities are less than $45 000 per QALY gained for the $5 and $15 prices, and greater than $65 000 per QALY gained for the $30 price. Conclusions. At a price of $5 or less per dose, buprenorphine maintenance is cost-effective under all scenarios we considered. At $15 per dose, it is cost-effective if its adoption does not lead to a net decline in methadone use, or if a medium to high value is assigned to the years of life lived by injection drug users and those in maintenance therapy. At $30 per dose, buprenorphine will be cost-effective only under the most optimistic modeling assumptions. (Review' s abstract) |
Note de contenu : | tabl. |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 44 |
Affiliation : |
Health Economics Resource Ctr., VA Palo Alto Health Care System, 795 Willow Rd (152 MPD), Menlo Park, CA 94025 ; paul.barnettmed.va.gov Etats-Unis. United States. |
Numéro Toxibase : | 208438 |
Centre Emetteur : | 02 Coordonnateur |
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