• Daniel Polsky, Henry A Glick, Jianing Yang, Geetha A Subramaniam, Sabrina A Poole, and George E Woody.
• PENN Medicine and the Wharton School, University of Pennsylvania, Blockley Hall, Philadelphia, PA 19104, USA. polsky@mail.med.upenn.edu
• Addiction. 2010 Sep 1; 105 (9): 1616-24.

AimsThe objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine-naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth.DesignEconomic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling.Participants152 patients aged 15-21 years.MeasurementsData were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12.FindingsThe 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25,049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100,000 per QALY.ConclusionsExtended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth.

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