The 130th Annual Meeting of APHA

5003.0: Wednesday, November 13, 2002 - 9:42 AM

Abstract #41376

Cost-utility of selective buprenorphine substitution for methadone maintenance in preventing HIV transmission

Harold A. Pollack, PhD, Health Management and Policy, University of Michigan School of Public Health, 109 Observatory, SPH II, Ann Arbor, MI 48109-2029 and Michael J. Wall, PharmD, University of Michigan & Pfizer Inc. Pharmacoeconomics and Outcomes Research Fellowship, University of Michigan, 109 Observatory, SPH II, Ann Arbor, MI 48109-2029, (734) 936-1298,

Injection drug users comprise >35% of new HIV cases, while an estimated 69.1% of patients currently enrolled in methadone maintenance programs (MMT) receive sub-optimal dosages (<80mg/d). Buprenorphine (BPN) has been suggested as an alternative to methadone due to less adverse effects and abuse potential. However, it has not consistently outperformed optimal dose MMT. OBJECTIVE: To compare the cost-utility of selective BPN substitution into current practice MMT, with emphasis on its role in HIV prevention. We also explore the cost-utility of increasing minimum methadone dosage from current practice. METHODS: We employed a dynamic epidemic (Markov) model to measure the effects of substituting BPN for sub-optimal methadone dosing (SubMT) (<60mg or <80mg/d) on health care costs and quality-adjusted life-years (QALYs) of intravenous heroin users. Analyses were performed with HIV prevalence of 5% or 40% within this population, considering a cost of $5 per day for BPN therapy. RESULTS: Substitution of BPN for SubMT <60mg, and <80mg, per day result in a cost per additional QALY of $1,827-$5,313, and $6,872-$17,687, respectively. Increasing the minimum dose of methadone to 80mg/d dominates all alternative treatment regimes. BPN is dominant over increasing minimum methadone doses to 60mg, but not to 80mg, if BPN increases quality of life by 1% over MMT through reduced adverse effects. CONCLUSIONS: Selective substitution of BPN for methadone is cost-effective for daily methadone doses below 60mg, and 80mg. BPN provides a useful additional treatment approach, though BPN appears less cost-effective than optimal-dose methadone therapy.

Learning Objectives:

Keywords: Substance Abuse Treatment, HIV/AIDS

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: University of Michigan Pfizer Inc

New Findings in Methadone Maintenance

The 130th Annual Meeting of APHA