Phillips-Jackson Helen, Hallam Clive, Cullen Niamh, Pearson Terry, Gilman Mark, Li Li, Musgrave Paul
Working Group on Innovation Assessment, Expert Faculty on Commissioning, London, UK.
Richmond and Wandsworth Council, London, UK.
Clinicoecon Outcomes Res. 2020 May 6;12:233-240. doi: 10.2147/CEOR.S242984. eCollection 2020.
To assess budget impact of the introduction of prolonged-release buprenorphine (PRB) for care of opioid use disorder (OUD) over 1 year in a defined population.
A healthcare perspective, decision-tree model analysis of the cost of OUD care for a standard population was prepared to compare two scenarios: treatment of a population under the existing standard of care, or with the addition of PRB. The model assessed OUD-related direct costs (medication, delivery, psychosocial treatment), other services costs (harm reduction, general healthcare, social and justice services) and the impact of behaviors such as engaging with treatment and electing to use additional opioids "on top" of treatment regimens, and "dropping out" from treatment.
Standard population definition (persons offered OUD care services) is based on a typical administrative region in England with general population of 400,000 citizens, 1,777 high-risk opioid users requiring treatment and 909 patients initiating treatment in a year. The cost to provide OUD care for 1 year under the current scenario (70% treated with methadone, 30% sublingual buprenorphine) is £19.7M. In scenarios with increased PRB adoption/reduced sublingual buprenorphine or oral methadone use, the cost reduction ranges from £0.2M to 0.7M.
The assessment showed a reduction of overall costs after introduction of PRB.
评估在特定人群中引入长效丁丙诺啡（PRB）用于阿片类物质使用障碍（OUD）护理一年的预算影响。
从医疗保健角度出发，针对标准人群进行了OUD护理成本的决策树模型分析，以比较两种情况：一是按照现有护理标准对人群进行治疗，二是在现有护理基础上增加PRB治疗。该模型评估了与OUD相关的直接成本（药物、给药、心理社会治疗）、其他服务成本（减少伤害、一般医疗保健、社会和司法服务），以及诸如参与治疗、选择在治疗方案基础上额外使用阿片类物质和退出治疗等行为的影响。
标准人群定义（接受OUD护理服务的人群）基于英格兰一个典型行政区，该行政区总人口为40万公民，有1777名需要治疗的高风险阿片类物质使用者，每年有909名患者开始治疗。在当前情况下（70%使用美沙酮治疗，30%使用舌下丁丙诺啡治疗），提供一年OUD护理的成本为1970万英镑。在增加PRB使用量/减少舌下丁丙诺啡或口服美沙酮使用量的情况下，成本降低范围为20万至70万英镑。
评估表明引入PRB后总体成本有所降低。
