Sean M Murphy1, Philip J Jeng1, Kathryn E McCollister2, Jared A Leff1, Ali Jalali1, Matisyahu Shulman3, Joshua D Lee4, Edward V Nunes3, Patricia Novo5, John Rotrosen5, Bruce R Schackman1. 1. Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA. 2. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. 3. New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA. 4. Department of Population Health, New York University School of Medicine, New York, NY, USA. 5. Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
Abstract
BACKGROUND AND AIMS: In a US randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72% XR-NTX versus 94% BUP-NX). DESIGN: This was a retrospective secondary analysis of CTN-0051 trial data, including follow-up data over 24-36 weeks. SETTING: Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the United States. PARTICIPANTS: A total of 283 participants randomized to receive XR-NTX. MEASUREMENTS: Efficiency was estimated using a multivariable generalized structural equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification + residential days). Cost-effectiveness was estimated from the health-care sector perspective and included expected costs and quality-adjusted life-years (QALYs). FINDINGS: Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5317 more than that of BUP-NX (P = 0.01) to a non-statistically-significant difference of $1016 (P = 0.63). QALYs gained remained similar across arms. CONCLUSION: Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the health-care sector perspective over 24-36 weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.
BACKGROUND AND AIMS: In a US randomized-effectiveness trial comparing extended-release naltrexone (XR-NTX) with buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse among participants recruited during inpatient detoxification (CTN-0051), the requirement to complete opioid detoxification prior to initiating XR-NTX resulted in lower rates of initiation of XR-NTX (72% XR-NTX versus 94% BUP-NX). DESIGN: This was a retrospective secondary analysis of CTN-0051 trial data, including follow-up data over 24-36 weeks. SETTING: Eight community-based, inpatient-detoxification and follow-up outpatient treatment facilities in the United States. PARTICIPANTS: A total of 283 participants randomized to receive XR-NTX. MEASUREMENTS: Efficiency was estimated using a multivariable generalized structural equation model to explore simultaneous determinants of XR-NTX induction and induction duration (detoxification + residential days). Cost-effectiveness was estimated from the health-care sector perspective and included expected costs and quality-adjusted life-years (QALYs). FINDINGS: Treatment site was the only modifiable factor that simultaneously increased the likelihood of XR-NTX induction and decreased induction duration. Incorporating the higher predicted probability of XR-NTX induction, and fewer predicted days of detoxification and subsequent residential treatment into the cost-effectiveness framework, reduced the incremental average 24-week total cost of XR-NTX treatment from $5317 more than that of BUP-NX (P = 0.01) to a non-statistically-significant difference of $1016 (P = 0.63). QALYs gained remained similar across arms. CONCLUSION: Adopting an efficient model of extended-release naltrexone initiation could result in extended-release naltrexone and buprenorphine-naloxone being of comparable economic value from the health-care sector perspective over 24-36 weeks for patients seeking treatment for opioid use disorder at an inpatient detoxification facility.
Authors: Maria Sullivan; Adam Bisaga; Martina Pavlicova; C Jean Choi; Kaitlyn Mishlen; Kenneth M Carpenter; Frances R Levin; Elias Dakwar; John J Mariani; Edward V Nunes Journal: Am J Psychiatry Date: 2017-01-10 Impact factor: 18.112
Authors: Adam Bisaga; Paolo Mannelli; Miao Yu; Narinder Nangia; Christine E Graham; D Andrew Tompkins; Thomas R Kosten; Sarah C Akerman; Bernard L Silverman; Maria A Sullivan Journal: Drug Alcohol Depend Date: 2018-04-10 Impact factor: 4.492
Authors: Kathryn E McCollister; Jared A Leff; Xuan Yang; Joshua D Lee; Edward V Nunes; Patricia Novo; John Rotrosen; Bruce R Schackman; Sean M Murphy Journal: Am J Manag Care Date: 2018-11 Impact factor: 2.229
Authors: Joshua D Lee; Edward V Nunes; Patricia Novo; Ken Bachrach; Genie L Bailey; Snehal Bhatt; Sarah Farkas; Marc Fishman; Phoebe Gauthier; Candace C Hodgkins; Jacquie King; Robert Lindblad; David Liu; Abigail G Matthews; Jeanine May; K Michelle Peavy; Stephen Ross; Dagmar Salazar; Paul Schkolnik; Dikla Shmueli-Blumberg; Don Stablein; Geetha Subramaniam; John Rotrosen Journal: Lancet Date: 2017-11-14 Impact factor: 79.321