The 130th Annual Meeting of APHA

Abstract #41376

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, haroldp@sph.umich.edu.

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:

• To compare the cost-utility of selective buprenorphine substitution into current practice methadone maintenance treatment, with emphasis on its role in HIV infection.

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