A cost-minimization analysis of telemedicine vs standard induction for buprenorphine: Evidence from a randomized...

In-person buprenorphine induction poses substantial cost and access barriers in India's opioid agonist treatment programs, while telemedicine-assisted induction may offer a scalable, lower-cost alternative.

To compare the societal costs of telemedicine-assisted buprenorphine induction (TABI) with standard care (SOC), while evaluating treatment retention and quality-of-life (QoL) outcomes.

An economic evaluation was embedded within a randomized controlled trial at a tertiary addiction treatment center, adopting a societal perspective. Health-system costs were estimated using a mixed top-down/bottom-up micro-costing approach for all participants (n = 138; SOC = 70, TABI = 68), while direct out-of-pocket and indirect wage-loss costs were assessed on day 7 in a predefined sub-sample (n = 57; SOC = 28, TABI = 29). Primary outcomes were 1-week retention and QoL; as effectiveness was comparable between arms, a cost-minimization analysis (CMA) was conducted.

Mean health-system cost per induction was INR 3,545 (USD 42.26) for SOC vs INR 2,690 (USD 32.06) for TABI (24% lower). In the out-of-pocket expenditure (OOP) sub-sample, mean direct patient costs were INR 1,857 (USD 22.13) for SOC vs INR 776 (USD 9.24) for TABI (P < 0.001); mean indirect costs were INR 1,502 (USD 17.91) vs INR 766 (USD 9.13). Total mean societal cost per patient was INR 6,904 (USD 82.33) for SOC vs INR 4,232 (USD 31.88) for TABI (39% saving). Treatment retention was similar between groups (SOC: 76% vs TABI: 82%; P = 0.339), and both demonstrated comparable improvements in QoL at 1 week (84.00 vs 84.17; P = 0.912).

Compared with standard induction, TABI substantially reduces health-system and patient costs, while maintaining comparable short-term retention and QoL.