OBJECTIVE: To compare outcomes, costs and incremental cost-effectiveness of heroin detoxification performed in a specialist clinic and in general practice. DESIGN AND SETTING: Randomised controlled trial set in a specialist outpatient drug treatment centre and six office-based general practices in inner city Sydney, Australia. PARTICIPANTS: 115 people seeking treatment for heroin dependence, of whom 97 (84%) were reinterviewed at Day 8, and 78 (68%) at Day 91. INTERVENTIONS: Participants were randomly allocated to primary care or a specialist clinic, and received buprenorphine for 5 days for detoxification, then were offered either maintenance therapy with methadone or buprenorphine, relapse prevention with naltrexone, or counselling alone. MAIN OUTCOME MEASURES: Completion of detoxification, engagement in post-detoxification treatment, and heroin use assessed at Days 8 and 91. Costs relevant to providing treatment, including staff time, medication use and diagnostic procedures, with abstinence from heroin use on Day 8 as the primary outcome measure. RESULTS: There were no significant differences in the proportions completing detoxification (40/56 [71%] primary care v 46/59 [78%] clinic), participating in postwithdrawal treatment (28/56 [50%] primary care v 36/59 [61%] clinic), reporting no opiate use during the withdrawal period (13/56 [23%] primary care v 13/59 [22%] clinic), and in duration of postwithdrawal treatment by survival analysis. Most participants in both groups entered postwithdrawal buprenorphine maintenance. On an intention-to-treat basis, self-reported heroin use in the month before the Day 91 interview was significantly lower than at baseline (27 days/month at baseline, 14 days/month at Day 91; P < 0.001) and did not differ between groups. Buprenorphine detoxification in primary care was estimated to be $24 more expensive per patient than treatment at the clinic. The incremental cost-effectiveness ratio reveals that, in this context, it costs $20 to achieve a 1% improvement in outcome in primary care. CONCLUSIONS:Buprenorphine-assisted detoxification from heroin in specialist clinic and primary care settings had similar efficacy and cost-effectiveness. Buprenorphine treatment can be initiated safely in primary care settings by trained GPs.
RCT Entities:
OBJECTIVE: To compare outcomes, costs and incremental cost-effectiveness of heroin detoxification performed in a specialist clinic and in general practice. DESIGN AND SETTING: Randomised controlled trial set in a specialist outpatient drug treatment centre and six office-based general practices in inner city Sydney, Australia. PARTICIPANTS: 115 people seeking treatment for heroin dependence, of whom 97 (84%) were reinterviewed at Day 8, and 78 (68%) at Day 91. INTERVENTIONS:Participants were randomly allocated to primary care or a specialist clinic, and received buprenorphine for 5 days for detoxification, then were offered either maintenance therapy with methadone or buprenorphine, relapse prevention with naltrexone, or counselling alone. MAIN OUTCOME MEASURES: Completion of detoxification, engagement in post-detoxification treatment, and heroin use assessed at Days 8 and 91. Costs relevant to providing treatment, including staff time, medication use and diagnostic procedures, with abstinence from heroin use on Day 8 as the primary outcome measure. RESULTS: There were no significant differences in the proportions completing detoxification (40/56 [71%] primary care v 46/59 [78%] clinic), participating in postwithdrawal treatment (28/56 [50%] primary care v 36/59 [61%] clinic), reporting no opiate use during the withdrawal period (13/56 [23%] primary care v 13/59 [22%] clinic), and in duration of postwithdrawal treatment by survival analysis. Most participants in both groups entered postwithdrawal buprenorphine maintenance. On an intention-to-treat basis, self-reported heroin use in the month before the Day 91 interview was significantly lower than at baseline (27 days/month at baseline, 14 days/month at Day 91; P < 0.001) and did not differ between groups. Buprenorphine detoxification in primary care was estimated to be $24 more expensive per patient than treatment at the clinic. The incremental cost-effectiveness ratio reveals that, in this context, it costs $20 to achieve a 1% improvement in outcome in primary care. CONCLUSIONS:Buprenorphine-assisted detoxification from heroin in specialist clinic and primary care settings had similar efficacy and cost-effectiveness. Buprenorphine treatment can be initiated safely in primary care settings by trained GPs.
Authors: Kelly E Dunn; Stacey C Sigmon; Eric C Strain; Sarah H Heil; Stephen T Higgins Journal: Drug Alcohol Depend Date: 2011-07-08 Impact factor: 4.492
Authors: Laura B Monico; Shannon Gwin Mitchell; Jan Gryczynski; Robert P Schwartz; Kevin E O'Grady; Yngvild K Olsen; Jerome H Jaffe Journal: J Subst Abuse Treat Date: 2015-05-07
Authors: James E Egan; Paul Casadonte; Tracy Gartenmann; Judith Martin; Elinore F McCance-Katz; Julie Netherland; John A Renner; Linda Weiss; Andrew J Saxon; David A Fiellin Journal: J Gen Intern Med Date: 2010-05-11 Impact factor: 5.128
Authors: T V Parran; C A Adelman; B Merkin; M E Pagano; R Defranco; R A Ionescu; A G Mace Journal: Drug Alcohol Depend Date: 2009-08-29 Impact factor: 4.492
Authors: Julie Netherland; Michael Botsko; James E Egan; Andrew J Saxon; Chinazo O Cunningham; Ruth Finkelstein; Mark N Gourevitch; John A Renner; Nancy Sohler; Lynn E Sullivan; Linda Weiss; David A Fiellin Journal: J Subst Abuse Treat Date: 2008-08-20