Doran Christopher M, Shanahan Marian, Mattick Richard P, Ali Robert, White Jason, Bell James
National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia.
Drug Alcohol Depend. 2003 Sep 10;71(3):295-302. doi: 10.1016/s0376-8716(03)00169-8.
This article presents the cost-effectiveness results of a randomised controlled trial conducted in two Australian cities. The trial was designed to assess the safety, efficacy and cost-effectiveness of buprenorphine versus methadone in the management of opioid dependence. The trial utilised a flexible dosing regime that was tailored to the clinical need of the patients, with high maximum doses, using the marketed formulation, under double-blind conditions. A total of 405 subjects were randomised to a treatment at one of three specialist outpatient drug treatment centres in Adelaide and Sydney, Australia. The perspective of the cost-effectiveness analysis was that of the service provider and included costs relevant to the provision of treatment. The primary outcome measure used in the economic analysis was change in heroin-free days from baseline to the sixth month of treatment. Treatment with methadone was found to be both less expensive and more effective than treatment with buprenorphine, which suggests methadone dominates buprenorphine. However, statistical testing found that the observed difference between the cost-effectiveness of methadone and buprenorphine treatments was not statistically significant. The results of this study provide useful policy information on the costs and outcomes associated with the use of methadone and buprenorphine and indicate that buprenorphine provides a viable alternative to methadone in the treatment of opioid dependence.
本文介绍了在澳大利亚两个城市进行的一项随机对照试验的成本效益结果。该试验旨在评估丁丙诺啡与美沙酮在治疗阿片类药物依赖方面的安全性、有效性和成本效益。试验采用了灵活的给药方案，根据患者的临床需求进行调整，使用市售制剂，在双盲条件下设置了较高的最大剂量。共有405名受试者被随机分配到澳大利亚阿德莱德和悉尼的三个专科门诊药物治疗中心之一接受治疗。成本效益分析的视角是服务提供者的视角，包括与提供治疗相关的成本。经济分析中使用的主要结果指标是从基线到治疗第六个月无海洛因天数的变化。结果发现，美沙酮治疗比丁丙诺啡治疗成本更低且更有效，这表明美沙酮优于丁丙诺啡。然而，统计检验发现，美沙酮和丁丙诺啡治疗的成本效益之间观察到的差异无统计学意义。本研究结果提供了关于使用美沙酮和丁丙诺啡的成本及结果的有用政策信息，并表明丁丙诺啡在治疗阿片类药物依赖方面是美沙酮的一种可行替代方案。
