- Title
- Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial
- Creator
- Dunlop, Adrian J.; Dunlop, AJ; Brown, AL; Oldmeadow, C; Attia, J; Harris, A; Ghijben, P; Sadler, C; Bell, J; Lintzeris, N; Brown, Amanda L.; Hinman, Jennifer; Jackson, Melissa; Bell, James; Lintzeris, Nicholas; Oldmeadow, Christopher; Harris, Anthony; Gill, Anthony; Sadler, Craig; Ribbons, Karen; Attia, John; Barker, Daniel; Ghijben, Peter
- Relation
- Drug and Alcohol Dependence Vol. 174, Issue 1 May 2017, p. 181-191
- Publisher Link
- http://dx.doi.org/10.1016/j.drugalcdep.2017.01.016
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Access to opioid agonist treatment can be associated with extensive waiting periods with significant health and financial burdens. This study aimed to determine whether patients with heroin dependence dispensed buprenorphine-naloxone weekly have greater reductions in heroin use and related adverse health effects 12-weeks after commencing treatment, compared to waitlist controls and to examine the cost-effectiveness of this strategy. Methods: An open-label waitlist RCT was conducted in an opioid treatment clinic in Newcastle, Australia. Fifty patients with DSM-IV-TR heroin dependence (and no other substance dependence) were recruited. The intervention group (n = 25) received take-home self-administered sublingual buprenorphine-naloxone weekly (mean dose, 22.7 ± 5.7 mg) and weekly clinical review. Waitlist controls (n = 25) received no clinical intervention. The primary outcome was heroin use (self-report, urine toxicology verified) at weeks four, eight and 12. The primary cost-effectiveness outcome was incremental cost per additional heroin-free-day. Results: Outcome data were available for 80% of all randomized participants. Across the 12-weeks, treatment group heroin use was on average 19.02 days less/month (95% CI -22.98, -15.06, p < 0.0001). A total 12-week reduction in adjusted costs including crime of $A5,722 (95% CI 3299, 8154) in favor of treatment was observed. Excluding crime, incremental cost per heroin-free-day gained from treatment was $A18.24 (95% CI 4.50, 28.49). Conclusion: When compared to remaining on a waitlist, take-home self-administered buprenorphine-naloxone treatment is associated with significant reductions in heroin use for people with DSM-IV-TR heroin dependence. This cost-effective approach may be an efficient strategy to enhance treatment capacity.
- Subject
- heroin dependence; buprenorphine; waiting lists; cost-benefit analysis; controlled clinical trial; crime
- Identifier
- http://hdl.handle.net/1959.13/1349603
- Identifier
- uon:30423
- Identifier
- ISSN:0376-8716
- Rights
- © 2017 Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- Language
- eng
- Full Text
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