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Heroin Addiction and Related Clinical Problems: 2015, 17, 1 (pages: 43 - 50)

Economic Evaluation of Suboxone® for substitution treatment of opioid drug dependence in Portugal

Gouveia M., Sousa R., Costa J., and Borges M.

Summary: Background: According to a recent Portuguese study the prevalence of lifetime consumption of heroin in the global population (between15 and 74 years) is 0,5%. Methadone is the standard pharmacological treatment and buprenorphine is available since 1999 as an alternative treatment. Nevertheless, no economic evaluation comparing the cost-effectiveness of these therapies is available at this point. Aim: This study estimates the cost-effectiveness and cost-utility of a fixed dose combination of buprenorphine-naloxone (B/N) versus methadone as substitution treatments for opioid drug dependence from the Portuguese social perspective. Material and Methods: The comparator was methadone, corresponding to the most common pharmacological strategy and current clinical practice in Portugal. Health gains were measured using the number of heroin-free days per year (indicator of effectiveness) and quality-adjusted life years (QALY) associated with each treatment. Estimated costs included acquisition, preparation and transport of medication; costs of dispensing and supervision of administration; costs with periodic monitoring of patients and non-medical direct costs of crime. Results: B/N combination is associated with an incremental cost-utility ratio of €5,914 per QALY gained. B/N combination is dominant when the analysis includes costs of crime associated with drug addiction. Conclusions: The results suggest that B/N combination is cost-effective and has the potential to generate health gains in the target population at low cost.