Buprenorphine, buprenorphine/naloxone and methadone maintenance: a cost-effectiveness analysis

The use of heroin in Australia results in disproportionate harm. Although the evidence suggests that a relatively low proportion of the population aged 14 years and over have ever used (1.4%) heroin or have used it in the past 12 months (0.2%), heroin use remains a significant cause of death, injury, illness and social harm. Research demonstrates that being in treatment leads to less heroin use, lowered mortality rates and reduced crime. Pharmacotherapy treatment in Australia involves methadone and buprenorphine. Trial data used by Doran and colleagues are used in the current analysis to extend the original analysis of methadone versus low-dose buprenorphine to include high-dose buprenorphine and the buprenorphine-naloxone combination in the maintenance of heroin dependence. Adopting a provider perspective suggests that the observed difference between the cost-effectiveness of methadone and the other treatments was not statistically significant, indicating that high-dose buprenorphine and the buprenorphine/naloxone combination can provide a viable alternative to methadone in the treatment of heroin dependence. Wider treatment choices provide greater potential to recruit a larger proportion of regular dependent users and retain them in treatment for longer. The forthcoming introduction of buprenorphine/naloxone to Australia provides an exciting opportunity to enhance the treatment of heroin dependence in this country.