Hunter Medical Research Institute, University of Newcastle, Lot 1 Kookaburra Cct, New Lambton Heights, NSW, 2305, Newcastle, Australia.
School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
BMC Health Serv Res. 2022 Nov 8;22(1):1326. doi: 10.1186/s12913-022-08687-8.
In 2019 daily liquid methadone and sublingual buprenorphine-naloxone were primary opioid agonist treatments for correctional centres in New South Wales, Australia. However, both had significant potential for diversion to other patients, and their daily administration was resource intensive. An alternative treatment in the form of subcutaneous depot buprenorphine became a viable option following a safety trial in 2020 - the UNLOC-T study. Depot preparation demonstrated advantages over current treatments as more difficult to divert and requiring fewer administrations. This paper reports the results of economic modelling of staffing costs in medication administration comparing depot buprenorphine, methadone, and sublingual buprenorphine provision in UNLOC-T trial facilities.
The costing study adopted a micro-costing approach involving the synthesis of cost data from the UNLOC-T clinical trial as well as data collected from Justice Health and Forensic Mental Health Network records. Labour and materials data were collected during site observations and interviews. Costs were calculated from two payer perspectives: a) the New South Wales (state) government which funds custodial and health services; and b) the Australian Commonwealth government, which pays for medications. The analysis compared the monthly-per-patient cost for each of the three medications in trial-site facilities during July 2019. This was followed by simulation of depot buprenorphine implementation across the study population. Costs associated with medical assessment and reviews were excluded.
The monthly-per-patient New South Wales government service costs of depot buprenorphine, methadone and sublingual buprenorphine were: $151, $379 and $1,529 respectively while Commonwealth government medication costs were $434, $80 and $525. The implementation simulation found that service costs of depot buprenorphine declined as patients transitioned from weekly to monthly administration. Costs of treatment using the other medications increased as patient numbers decreased alongside fixed costs. At 12 months, monthly-per-patient service costs for depot buprenorphine, methadone and sublingual buprenorphine-which would be completely phased out by month 13-were $92, $530 and $2,162 respectively.
Depot buprenorphine was consistently the least costly of the treatment options. Future modelling could allow for dynamic patient populations and downstream impacts for participants and the state health system.
ACTRN12618000942257 . Registered 4 June 2018.
2019 年，在澳大利亚新南威尔士州的惩教中心，每日液体美沙酮和舌下丁丙诺啡-纳洛酮是主要的阿片类药物激动剂治疗方法。然而，这两种药物都有很大的潜在风险被转移给其他患者，而且它们的日常管理需要大量的资源。2020 年，一项安全试验（UNLOC-T 研究）后，皮下丁丙诺啡储存制剂成为一种可行的选择。储存制剂与当前治疗方法相比具有优势，因为它更难转移，而且需要的给药次数更少。本文报告了在 UNLOC-T 试验设施中比较丁丙诺啡储存制剂、美沙酮和舌下丁丙诺啡给药的药物管理人员配置成本的经济建模结果。
成本研究采用微观成本法，综合了 UNLOC-T 临床试验的成本数据以及从司法卫生和法医心理健康网络记录中收集的数据。劳动和材料数据是在现场观察和访谈期间收集的。成本从两个付款人角度计算：a）为惩教和卫生服务提供资金的新南威尔士州（州）政府；b）支付药物费用的澳大利亚联邦政府。该分析比较了 2019 年 7 月试验点设施中三种药物的每位患者每月的成本。随后，对丁丙诺啡储存制剂在整个研究人群中的实施情况进行了模拟。不包括与医疗评估和审查相关的成本。
新南威尔士州政府为丁丙诺啡储存制剂、美沙酮和舌下丁丙诺啡提供的每位患者每月服务成本分别为：151 美元、379 美元和 1529 美元，而联邦政府的药物成本分别为：434 美元、80 美元和 525 美元。实施模拟发现，随着患者从每周给药转为每月给药，丁丙诺啡储存制剂的服务成本下降。随着患者数量减少和固定成本增加，使用其他药物治疗的成本增加。在 12 个月时，丁丙诺啡储存制剂、美沙酮和舌下丁丙诺啡的每位患者每月服务成本（第 13 个月将完全淘汰）分别为 92 美元、530 美元和 2162 美元。
丁丙诺啡储存制剂始终是治疗选择中成本最低的。未来的建模可以考虑动态患者人群以及参与者和州卫生系统的下游影响。
ACTRN12618000942257。2018 年 6 月 4 日注册。
