Authors' objectives:

"The primary objective of this assessment report was to assess the clinical and cost-effectiveness of buprenorphine maintenance therapy (BMT) and methadone maintenance therapy (MMT) for the management of opioid-dependent individuals from the perspective of the NHS and Personal Social Services (PSS).

Although methadone is the mainstay drug used in current practice, for the purposes of this report we sought to address three specific questions:

Is MMT effective and cost-effective compared with no drug therapy? Is BMT effective and cost-effective compared with no drug therapy? Is MMT or BMT more effective and cost-effective? We also sought to explore the variation in effectiveness of BMT and MMT across drug doses, patient subgroups and treatment settings; assess the cost-effectiveness of BMT and MMT from a wider societal perspective; and compare the effectiveness of BMT with buprenorphine detoxification therapy (BDT) and MMT with methadone detoxification therapy (MDT)." (from executive summary)

Authors' recommendations: Implications for service provision Both flexible-dose MMT and BMT are more clinically effective and more cost-effective than no drug therapy in dependent opiate users. In direct comparison, a flexible dosing strategy with MMT (daily dose equivalent 20;120 mg) was found to be somewhat more effective in maintaining individuals in treatment than flexible-dose BMT (daily dose equivalent 4;16 mg) and therefore associated with a slightly higher health gain and lower costs. However, this needs to be balanced by the more recent experience of clinicians in the use of buprenorphine, the possible risk of higher mortality of MMT and individual opiate-dependent users- preferences. Suggested research priorities Future research should be directed towards the safety and effectiveness of MMT and BMT as it is delivered in the UK, potential safety concerns regarding methadone and buprenorphine, specifically mortality and key drug interactions, efficacy of substitution medications (in particular patient subgroups, such as within the criminal justice system, or within young people) and uncertainties in cost-effectiveness identified by current economic models.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1492

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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