Cost‐effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial

Abstract

In patients with severe opioid use disorder enrolled into the SALOME trial, injectable hydromorphone provided similar outcomes to injectable diacetylmorphine. Modelling outcomes during a patient's life-time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost-saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.

Evidence on the Effectiveness of Heroin-Assisted Treatment

“…The four HAT source studies discussed in these reviews were all captured by our search strategy. Our search yielded two additional studies evaluating the costs or cost-benefits of HAT (Frei, 2001;van den Brink and Blanken, 2002), and we became aware of one recent relevant cost-effectiveness study published outside our search timeframe (Bansback et al, 2018).…”

“…Canadian SALOME Trial. Bansback et al (2018) compared the cost-effectiveness of supervised injectable heroin and supervised injectable hydromorphone based on findings from the SALOME trial. Their analyses adopted a societal perspective and considered a within-trial timeframe of 6 months as well as a lifetime timeframe.…”

“…Our search strategy for heroin-assisted treatment yielded 3,326 de-duplicated records. We also became aware of two relevant studies (Bansback et al, 2018;Nikoo et al, 2018) evaluating the results of heroin-assisted treatment RCTs published after the end period of our database search, resulting in a total of 3,328 records. Based on the title and abstract screening, we excluded 3,039 of these documents as not meeting our inclusion criteria.…”

Commentary on Bansback et al. (2018): Estimating the cost of stigma against injection

“…This carefully executed cost and cost‐effectiveness study, conducted alongside the Study to Assess Long‐term Opioid Medication Effectiveness (SALOME) trial, investigates the economic value, or cost‐effectiveness, of injectable hydromorphone, injectable diacetylmorphine and oral methadone maintenance for patients with severe opioid use disorder (OUD) who have tried methadone previously . The study demonstrates methodological rigor as defined by the second panel on cost‐effectiveness in medicine .…”

“…The study by Bansback et al . suggests that implementing injectable therapy for some of the most difficult‐to‐treat patients with OUD could potentially improve outcomes without increased cost—a rarity in innovation in medicine treatment. Unfortunately, however, this paper and the arguments it makes are unlikely to motivate legislation permitting injected opioid treatment.…”