Caplehorn John, Deeks Jonathan J
Clinical Epidemiology, School of Public Health, University of Sydney, Australia.
Drug Alcohol Rev. 2006 Mar;25(2):157-60. doi: 10.1080/09595230600681527.
While there are serious problems with the analyses and reports, the Australian comparative trial of methadone and buprenorphine maintenance has generated very useful data. Contrary to the triallists' conclusions, their study provides good evidence that methadone is better than buprenorphine at retaining addicts in programmes where clinicians can adjust their patients' daily doses. The trial also provides the first evidence that methadone is significantly cheaper than buprenorphine maintenance. The savings from less frequent clinic attendance were more than offset by the extra time spent dispensing buprenorphine and the greater cost of the buprenorphine itself. In cost-effectiveness terms, the trial's results show methadone 'dominates' buprenorphine as an opioid maintenance drug because it is not only more effective but also cheaper.
虽然分析和报告存在严重问题，但澳大利亚的美沙酮与丁丙诺啡维持治疗对比试验产生了非常有用的数据。与试验者的结论相反，他们的研究提供了充分证据，表明在临床医生可以调整患者每日剂量的项目中，美沙酮在留住成瘾者方面比丁丙诺啡更有效。该试验还首次证明，美沙酮维持治疗的成本明显低于丁丙诺啡。因就诊次数减少节省的费用，被丁丙诺啡配药所花费的额外时间以及丁丙诺啡本身更高的成本所抵消。从成本效益角度来看，该试验结果表明，作为阿片类维持药物，美沙酮“优于”丁丙诺啡，因为它不仅更有效，而且更便宜。
