Modeling the cost-effectiveness and impact on fatal overdose and initiation of buprenorphine-naloxone treatment at syringe service programs.
Analgesics, Opioid
/ therapeutic use
Buprenorphine
/ therapeutic use
Buprenorphine, Naloxone Drug Combination
/ therapeutic use
Cost-Benefit Analysis
Drug Overdose
/ drug therapy
Humans
Narcotic Antagonists
Opiate Overdose
Opiate Substitution Treatment
/ methods
Opioid-Related Disorders
/ epidemiology
Syringes
Cost-effectiveness analysis
injection drug use
medications for opioid use disorder
opioid use disorder
simulation modeling
treatment access
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
received:
11
05
2021
accepted:
06
03
2022
pubmed:
23
3
2022
medline:
9
9
2022
entrez:
22
3
2022
Statut:
ppublish
Résumé
To estimate the number of treatment initiations, averted fatal opioid overdoses and the cost-effectiveness associated with offering buprenorphine-naloxone (buprenorphine) treatment on-site within existing syringe service programs (SSPs) in Massachusetts, USA. This was a cohort-based mathematical model and cost-effectiveness analysis. We derived model inputs from state and national surveillance data, clinical trials and observational cohort studies. We compared an intervention scenario where 30% of SSP clients initiated buprenorphine treatment on-site at least once annually to a status quo scenario where no buprenorphine was available on-site among community treatment providers in Massachusetts, 2020-30. In individuals with opioid use disorder (OUD) we assumed that 80% of SSP clients had recently injected drugs and that treatment within SSPs would have similar or improved retention compared with standard-of-care buprenorphine programs, but higher rates of active opioid use while in treatment. Number of treatment initiations (i.e. individuals began treatment on a medication for opioid use disorder or entered medically managed withdrawal), averted fatal opioid overdoses, quality-adjusted life-years (QALYs) and life-time discounted costs from a health sector and a limited societal perspective. The status quo scenario resulted in 23 051 fatal overdoses and 1 511 613 treatment initiations over a 10-year simulation period. An intervention scenario with on-site SSP buprenorphine treatment averted 4797 (-20.8%) fatal opioid overdoses and resulted in 129 359 (+8.6%) additional treatment initiations compared with the status quo. The intervention scenario was the dominating scenario: providing OUD treatment through Massachusetts SSPs cost less (-$3612 per person) with patients accumulating more QALYs (0.2 per person) compared with the status quo scenario. Offering buprenorphine treatment on-site within syringe service programs has the potential to decrease fatal overdoses substantially, improve treatment engagement and save on costs.
Identifiants
pubmed: 35315148
doi: 10.1111/add.15883
pmc: PMC9951221
mid: NIHMS1804703
doi:
Substances chimiques
Analgesics, Opioid
0
Buprenorphine, Naloxone Drug Combination
0
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2635-2648Subventions
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI052074
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA044878
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Society for the Study of Addiction.
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