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Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

AIMS: To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. DESIGN: We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to de...

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Autores principales: Ruger, Jennifer Prah, Chawarski, Marek, Mazlan, Mahmud, Ng, Nora, Schottenfeld, Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514172/
https://www.ncbi.nlm.nih.gov/pubmed/23226534
http://dx.doi.org/10.1371/journal.pone.0050673
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author Ruger, Jennifer Prah
Chawarski, Marek
Mazlan, Mahmud
Ng, Nora
Schottenfeld, Richard
author_facet Ruger, Jennifer Prah
Chawarski, Marek
Mazlan, Mahmud
Ng, Nora
Schottenfeld, Richard
author_sort Ruger, Jennifer Prah
collection PubMed
description AIMS: To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. DESIGN: We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants’ time were estimated using Malaysia’s minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars. SETTING: Muar, Malaysia. PARTICIPANTS: 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003–2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence. MEASUREMENTS: Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores. FINDINGS: Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine. CONCLUSIONS: Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.
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spelling pubmed-35141722012-12-05 Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia Ruger, Jennifer Prah Chawarski, Marek Mazlan, Mahmud Ng, Nora Schottenfeld, Richard PLoS One Research Article AIMS: To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. DESIGN: We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants’ time were estimated using Malaysia’s minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars. SETTING: Muar, Malaysia. PARTICIPANTS: 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003–2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence. MEASUREMENTS: Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores. FINDINGS: Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine. CONCLUSIONS: Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term. Public Library of Science 2012-12-04 /pmc/articles/PMC3514172/ /pubmed/23226534 http://dx.doi.org/10.1371/journal.pone.0050673 Text en © 2012 Ruger et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Ruger, Jennifer Prah
Chawarski, Marek
Mazlan, Mahmud
Ng, Nora
Schottenfeld, Richard
Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title_full Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title_fullStr Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title_full_unstemmed Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title_short Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia
title_sort cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in malaysia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514172/
https://www.ncbi.nlm.nih.gov/pubmed/23226534
http://dx.doi.org/10.1371/journal.pone.0050673
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