Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia

Ruger JP, Chawarski M, Mazlan M, Ng N, Schottenfeld R. Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia. PloS ONE. 2012;7(12):e50673.

10 Pages Posted: 21 Dec 2010 Last revised: 14 Oct 2014

See all articles by Jennifer Prah Ruger

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine

Marek Chawarski

Yale School of Medicine

Mahmud Mazlan

Substance Abuse Center

Nora Y. Ng

Yale University

Richard Schottenfeld

Yale School of Medicine

Date Written: 2008

Abstract

Aims: To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.

Design: We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants’ time were estimated using Malaysia’s minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.

Setting: Muar, Malaysia.

Participants: 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003–2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.

Measurements: Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.

Findings: Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.

Conclusions: Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Keywords: cost-effectiveness, buprenorphine, naltrexone, heroin dependence, Malaysia

JEL Classification: I18, I10, I12

Suggested Citation

Prah Ruger, Jennifer and Chawarski, Marek and Mazlan, Mahmud and Ng, Nora Y. and Schottenfeld, Richard, Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia (2008). Ruger JP, Chawarski M, Mazlan M, Ng N, Schottenfeld R. Cost-Effectiveness of Buprenorphine and Naltrexone Treatments for Heroin Dependence in Malaysia. PloS ONE. 2012;7(12):e50673., Available at SSRN: https://ssrn.com/abstract=1728867

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States

Marek Chawarski

Yale School of Medicine ( email )

New Haven, CT 06520
United States

Mahmud Mazlan

Substance Abuse Center ( email )

185-1 Jalan Abdul Rahman 84 000
Muar Johor
Malaysia

Nora Y. Ng

Yale University ( email )

New Haven, CT 06520
United States

Richard Schottenfeld

Yale School of Medicine ( email )

New Haven, CT 06520
United States

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