Exploratory Economic Evaluation of Buprenorphine Treatment in Opioid Use Disorder

Hesham Farouk Elarabi, Hamad Al Ghaferi, Nael Hasan, Amanda J. Lee, Mansour Shawky, Helal Al Kathiri, Abuelgasim Elrasheed, Samya Al Maamari, Tarek A. Gawad, Doaa Radwan, Abdu Adem, John Marsden

    Research output: Contribution to journalArticlepeer-review


    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.

    Original languageEnglish
    Pages (from-to)89-95
    Number of pages7
    JournalThe journal of mental health policy and economics
    Issue number3
    Publication statusPublished - 1 Sep 2021

    Bibliographical note

    Funding information: None declared.

    Open Access: No Open Access licence.

    Publishers copyright: © 2021 ICMPE

    Citation: Elarabi HF, Al Ghaferi H, Hasan N, Lee AJ, Shawky M, Al Kathiri H, Elrasheed A, Al Maamari S, Gawad TA, Radwan D, Adem A, Marsden J. Exploratory Economic Evaluation of Buprenorphine Treatment in Opioid Use Disorder. J Ment Health Policy Econ. 2021 Sep 1;24(3):89-95.

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