Cost‐effectiveness of extended release naltrexone to prevent relapse among criminal justice‐involved individuals with a history of opioid use disorder

Background and Aims Criminal justice‐involved individuals are highly susceptible to opioid relapse and overdose‐related deaths. In a recent randomized trial, we demonstrated the effectiveness of extended‐release naltrexone (XR‐NTX; Vivitrol®) in preventing opioid relapse among criminal justice‐involved US adults with a history of opioid use disorder. The cost of XR‐NTX may be a significant barrier to adoption. Thus, it is important to account for improved quality of life and downstream cost‐offsets. Our aims were to (1) estimate the incremental cost per quality‐adjusted life‐year (QALY) gained for XR‐NTX versus treatment as usual (TAU) and evaluate it relative to generally accepted value thresholds; and (2) estimate the incremental cost per additional year of opioid abstinence. Design Economic evaluation of the aforementioned trial from the taxpayer perspective. Participants were randomized to 25 weeks of XR‐NTX injections or TAU; follow‐up occurred at 52 and 78 weeks. Setting Five study sites in the US Northeast corridor. Participants A total of 308 participants were randomized to XR‐NTX (n = 153) or TAU (n = 155). Measurements Incremental costs relative to incremental economic and clinical effectiveness measures, QALYs and abstinent years, respectively. Findings The 25‐week cost per QALY and abstinent‐year figures were $162 150 and $46 329, respectively. The 78‐week figures were $76 400/QALY and $16 371/abstinent year. At 25 weeks, we can be 10% certain that XR‐NTX is cost‐effective at a value threshold of $100 000/QALY and 62% certain at $200 000/QALY. At 78 weeks, the cost‐effectiveness probabilities are 59% at $100 000/QALY and 76% at $200 000/QALY. We can be 95% confident that the intervention would be considered ‘good value’ at $90 000/abstinent year at 25 weeks and $500/abstinent year at 78 weeks. Conclusions While extended‐release naltrexone appears to be effective in increasing both quality‐adjusted life‐years (QALYs) and abstinence, it does not appear to be cost‐effective using generally accepted value thresholds for QALYs, due to the high price of the injection.