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Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial.

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  • معلومة اضافية
    • المصدر:
      Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9304118 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0443 (Electronic) Linking ISSN: 09652140 NLM ISO Abbreviation: Addiction Subsets: MEDLINE
    • بيانات النشر:
      Publication: Oxford : Wiley-Blackwell
      Original Publication: Abingdon, Oxfordshire, UK : Carfax Pub. Co., c1993-
    • الموضوع:
      Hydromorphone/*therapeutic use ; Narcotics/*therapeutic use ; Opiate Substitution Treatment/*methods ; Opioid-Related Disorders/*drug therapy; British Columbia ; Cost-Benefit Analysis ; Crime/economics ; Crime/statistics & numerical data ; Double-Blind Method ; Equivalence Trials as Topic ; Health Services/economics ; Health Services/statistics & numerical data ; Heroin/economics ; Heroin/therapeutic use ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Hydromorphone/economics ; Methadone/economics ; Methadone/therapeutic use ; Mortality ; Narcotics/economics ; Opiate Substitution Treatment/economics ; Opioid-Related Disorders/economics ; Quality-Adjusted Life Years ; Randomized Controlled Trials as Topic ; Severity of Illness Index
    • نبذة مختصرة :
      Background and Aims: Previous research has found diacetylmorphine, delivered under supervision, to be cost-effective in the treatment of severe opioid use disorder, but diacetylmorphine is not available in many settings. The Study to Assess Long-term Opioid Maintenance Effectiveness (SALOME) randomized controlled trial provided evidence that injectable hydromorphone is non-inferior to diacetylmorphine. The current study aimed to compare the cost-effectiveness of hydromorphone directly with diacetylmorphine and indirectly with methadone maintenance treatment.
      Design: A within-trial analysis was conducted using the patient level data from the 6-month, double-blind, non-inferiority SALOME trial. A life-time analysis extrapolated costs and outcomes using a decision analytical cohort model. The model incorporated data from a previous trial to include an indirect comparison to methadone maintenance.
      Setting: A supervised clinic in Vancouver, British Columbia, Canada.
      Participants: A total of 202 long-term street opioid injectors who had at least two attempts at treatment, including one with methadone (or other substitution), were randomized to hydromorphone (n = 100) or diacetylmorphine (n = 102).
      Measurements: We measured the utilization of drugs, visits to health professionals, hospitalizations, criminal activity, mortality and quality of life. This enabled us to estimate incremental costs, quality-adjusted life years (QALYs) and cost-effectiveness ratios from a societal perspective. Sensitivity analyses considered different sources of evidence, assumptions and perspectives.
      Findings: The within-trial analysis found hydromorphone provided similar QALYs to diacetylmorphine [0.377, 95% confidence interval (CI) = 0.361-0.393 versus 0.375, 95% CI = 0.357-0.391], but accumulated marginally greater costs [$49 830 ($28 401-73 637) versus $34 320 ($21 780-55 998)]. The life-time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone [8.4 (7.4-9.5) and 8.3 (7.2-9.5) versus 7.4 (6.5-8.3) QALYs] at lower cost [$1.01 million ($0.6-1.59 million) and $1.02 million ($0.72-1.51 million) versus $1.15 million ($0.71-1.84 million)].
      Conclusions: In patients with severe opioid use disorder enrolled into the SALOME trial, injectable hydromorphone provided similar outcomes to injectable diacetylmorphine. Modelling outcomes during a patient's life-time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost-saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.
      (© 2018 Society for the Study of Addiction.)
    • Comments:
      Comment in: Addiction. 2018 Jul;113(7):1274-1275. doi: 10.1111/add.14219. (PMID: 29883035)
    • Grant Information:
      MCT‐103817 Canada CAPMC CIHR
    • Contributed Indexing:
      Keywords: Cost-effectiveness; economics; injectable diacetylmorphine; injectable hydromorphone; methadone maintenance therapy; opioid dependence
    • الرقم المعرف:
      0 (Narcotics)
      70D95007SX (Heroin)
      Q812464R06 (Hydromorphone)
      UC6VBE7V1Z (Methadone)
    • الموضوع:
      Date Created: 20180329 Date Completed: 20191209 Latest Revision: 20191217
    • الموضوع:
      20250114
    • الرقم المعرف:
      10.1111/add.14171
    • الرقم المعرف:
      29589873