Department of Public Health, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
PLoS One. 2012;7(12):e50673. doi: 10.1371/journal.pone.0050673. Epub 2012 Dec 4.
To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.
We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.
Muar, Malaysia.
126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.
Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.
Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.
Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.
为了辅助公共卫生决策，我们研究了丁丙诺啡、纳曲酮和安慰剂干预对马来西亚海洛因依赖的成本效益。
我们估算了三种海洛因依赖治疗方案的成本效益比。我们使用微观成本分析法来确定每种干预措施的固定、可变和社会成本。成本数据来自调查人员、工作人员和项目记录，记录了使用资源的数量和类型以及单位成本；根据马来西亚最低工资，估算了参与者时间的社会成本。从提供者和社会角度对成本进行了估算，并按 2004 年美元报告。
马来西亚麻坡。
126 名参加马来西亚随机、双盲、安慰剂对照临床试验的患者（2003-2005 年），接受过治疗海洛因依赖的咨询以及丁丙诺啡、纳曲酮或安慰剂治疗。
主要结局指标包括治疗天数、最长连续的海洛因戒断天数、首次使用海洛因的天数和海洛因复发的天数。次要结局指标包括治疗保留率、注射毒品使用、非法阿片类药物使用、艾滋病风险清单总分以及药物风险和性风险子分。
丁丙诺啡在所有主要和大多数次要结局方面均比纳曲酮更有效且更昂贵。增量成本效益比在主要结局方面低于 50 美元，在大多数次要结局方面低于 350 美元。纳曲酮在所有次要结局方面均在几乎所有终点上都被安慰剂所主导。增量治疗成本主要由药物成本驱动，尤其是丁丙诺啡的价格。
丁丙诺啡似乎是一种比纳曲酮更具成本效益的选择，可能会在更长时间内提高经济生产力并减少药物使用。
