Cost-effectiveness of office-based buprenorphine treatment for opioid use disorder.

Aim: To assess the effectiveness and cost-effectiveness of office-based buprenorphine treatment (OBBT) in the U.S.
Design Setting and Participants: We performed a model-based analysis of buprenorphine treatment provided in a primary care setting for the U.S. population with OUD.
Intervention: Buprenorphine treatment provided in a primary care setting.
Measurements: Fatal and nonfatal overdoses and deaths over five years, discounted lifetime quality-adjusted life years (QALYs), costs.
Findings: For a cohort of 100,000 untreated individuals who enter OBBT, approximately 9350 overdoses would be averted over five years; of these, approximately 900 would have been fatal. OBBT compared to no treatment would yield 1.07 incremental lifetime QALYs per person at an incremental cost of $17,000 per QALY gained when using a healthcare perspective. If OBBT is half as effective and twice as expensive as assumed in the base case, the incremental cost when using a healthcare perspective is $25,500 per QALY gained. Using a limited societal perspective that additionally includes patient costs and criminal justice costs, OBBT is cost-saving compared to no treatment even under pessimistic assumptions about efficacy and cost.
Conclusions: Expansion of OBBT would be highly cost-effective compared to no treatment when considered from a healthcare perspective, and cost-saving when reduced criminal justice costs are included. Given the continuing opioid crisis in the U.S., expansion of this care option should be a high priority.
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