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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 24, Issue 3, 2021. Pages: 89-95
Published Online: 1 September 2021

Copyright © 2021 ICMPE.


 

Exploratory Economic Evaluation of Buprenorphine Treatment in Opioid Use Disorder

Hesham Farouk Elarabi,1* Hamad Al Ghaferi,2 Nael Hasan,2 Amanda J Lee,3 Mansour Shawky,4 Helal Al Kathiri,2 Abuelgasim Elrasheed,2 Samya Al Maamari,2 Tarek A. Gawad,5 Doaa Radwan,6 Abdu Adem,7 John Marsden8

1National Rehabilitation Centre, Abu Dhabi, United Arab Emirates & Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
2National Rehabilitation Centre, Abu Dhabi, United Arab Emirates
3Medical Statistics Team - University of Aberdeen, United Kingdom
4National Rehabilitation Centre, Abu Dhabi, United Arab Emirates & Faculty of Medicine, Assuit University, Egypt
5Faculty of Medicine - Cairo University, Egypt
6Institute of Psychiatry - Aim Shams University, Egypt
7Faculty of Medicine, Khalifa University, United Arab Emirates
8Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom

* Correspondence to: Hesham Farouk Elarabi, National Rehabilitation Centre, PO Box 55001 Abu Dhabi, Shakhboot City, United Arab Emirates.
E-mail: Hesham.alarabi@nrc.gov.ae

Source of Funding: None declared.

Abstract
Estimating Impairment Weight (IW) at patient level using psychometric tools is an alternative to non-population specific Disability Weight overestimated by economic methods. This study estimated the burden of opioid use disorder (OUD) and the cost-benefit of buprenorphine/naloxone along-side a randomized clinical trial. Participants with OUD (n=141) were randomized to experimental and control arms.  IW was estimated on a ‘0’ to ‘1’ scale (‘0’ = no impairment, ‘1’= full impairment) using the Work and Social Adjustment Scale.Median annual cost of OUD per participant was AED 498,171.1 (413,499.0 – 635,725.3) and AED 538,694.4 (4,211,398.0 – 859,949.0) and IW was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At study end, 51% reduction was observed in the experimental IW (0.26 (SD 0.28) compared to 27% in the control (0.42; SD 0.33). A return-on-investment of 1.55 and 1.29 was established in the experimental and control groups, respectively.

 

Background: Burden of opioid use disorder (OUD) is expressed in economic values or health metrics like Disability Adjusted Life Years (DALYs). Disability Weight (DW), a component of DALYs is estimated using economic methods or psychometric tools. Estimating DW at patient level using psychometric tools is an alternative to non-population specific DW overestimated by economic methods. Providing Medication Assisted Treatment (MAT) using buprenorphine/naloxone film (BUP/NX-F) for OUD is limited by financial constraints.

Aim: To estimate the burden of OUD at patient level and explore the cost-benefit of two buprenorphine treatment interventions.

Methods: The present study was conducted alongside a randomized controlled trial of 141 adults with OUD stabilized on BUP/NX-F and randomized to BUP/NX-F with Incentivized Abstinence and Adherence Monitoring (experimental, n=70) and BUP/NX-F in usual care (control, n=71). The cost of illness was estimated applying a societal perspective. The Impairment Weight (IW) was estimated over a ‘0’ to ‘1’ scale, where ‘0’ represents no impairment and ‘1’ full impairment using the Work and Social Adjustment Scale (WSAS).

Results: Median (interquartile range) annual cost of OUD per participant was AED 498,171.1 (413,499.0 –635,725.3) and AED 538,694.4 (4,211,398.0 – 659,949.0) in the experimental and control groups, respectively (p=0.33). Illicit drug purchase represented 60 % of the annual cost of illness. At baseline, the mean Impairment Weight (IW) was 0.55 (SD 0.26) and 0.62 (SD 0.24) in the experimental and control groups, respectively. At end of the study, the IW was 0.26 (SD 0.28) representing 51% reduction in the experimental group compared to 0.42 (SD 0.33) in the control group representing a 27% reduction. Excluding imprisonment, the cost-benefit of treatment was not realized. In contrast, accounting for imprisonment, cost benefit expressed as a return-on-investment was established at 1.55 and 1.29 in the experimental and control groups, respectively.

Implications for Mental Health Policy: Cost benefit analysis can serve as a simple and practical tool to evaluate the cost benefit of treatment interventions. Demonstrating the cost benefit of buprenorphine treatment has the potential to facilitate public funding and accessibility to opioid assisted treatment.

Received 13 February 2021; accepted 30 July 2021

Copyright 2021 ICMPE