Background
Methods
Model
From: | MAW | HTP | LITP | |
---|---|---|---|---|
To:
|
Methadone
|
B/N
| ||
MAW
| 50.0% | 5.0% | 18.0% | 0.0% |
HTP
| 35.0% | 75.0% | 63.0% | 5.0% |
LITP
| 15.0% | 20.0% | 19.0% | 95.0% |
Population
Treatment options
Time horizon, perspective and discounting
Resources and costs
HTP | LITP | ||||||
---|---|---|---|---|---|---|---|
Resource
|
MAW
|
Methadone 1
st
year
|
Methadone
2
nd
& 3
rd
year
|
B/N 1
st
year
|
B/N
2
nd
& 3
rd
year
|
Methadone
|
B/N
|
Distribution
| 365 | 365 | |||||
Production
| 365 | 365 | 365 | ||||
Dispensing
| 36 | 104 | 52 | 52 | |||
Supervision
| |||||||
drug-pharmacy | 36 | 365 | 365 | 365 | |||
medical/clinical | 6 | 6 | |||||
psychological | 20 | 20 | 10 | 20 | 5 | ||
social worker | 15 | 10 | 10 | 10 | 5 | 6 | 6 |
psychiatric | 10 | 10 | 10 | 10 | 5 | ||
Monitoring (analytical controls)
| 36 | 12 | 12 | 12 |
Resource | Cost (€, 2010) |
---|---|
Drugs
| |
Methadone | 531.80 € per methadone kg |
Buprenorphine/Naloxone combination (Suboxone®, 8/2 mg, 7 tablets) | 2.37€ per tablet |
Logistics
| |
Distribution | 0.17€/min |
Production | 0.49€/min |
Dispensing | |
Nurse
| 0.28€/min |
Supervision
| |
Drug-pharmacy | 0.49€/min |
Medical/clinical | 0.49€/min |
Psychological | 0.49€/min |
Social worker | 0.28€/min |
Psychiatric | 0.49€/min |
Monitoring (analytical controls)
| 3.81€/test |
Sensitivity analyses
-
Transition probabilities: The same values applied for methadone were also assumed for B/N combination.
-
Patients commencing B/N combination: In Spain there is only an Autonomous Region (Murcia) where B/N combination is fully financed by the Regional Health Care System with a free access to the drug. A sensitivity analysis with the proportion of patients starting B/N combination treatment over the previous three years available for this region was performed (0.97%, 2.57% and 3.83%) [36]
-
Initial distribution of patients: Influence of 100% of patients in LITP or 100% of patients in HTP was tested.
-
Resource costs: Differences of ± 10% in cost per minute of resources were tested.
Results
Treatment population: patients on AOT programs
Budgetary impact
Scenario without B/N combination | Scenario with B/N combination | Difference (€) with B/N vs. without B/N | ||
---|---|---|---|---|
1st year
| MAW | 1,724,290 | 2,312,217 | 587,927 |
HTP | 28,428,367 | 28,541,622 | 113,255 | |
LITP | 55,613,472 | 55,735,372 | 121,900 | |
2
nd
year
| MAW | 1,711,926 | 2,416,973 | 705,047 |
HTP | 22,380,263 | 22,181,969 | -198,294 | |
LITP | 55,763,283 | 55,799,317 | 36,034 | |
3
rd
year
| MAW | 1,747,500 | 2,642,079 | 894,579 |
HTP | 20,796,602 | 20,476,162 | -320,440 | |
LITP | 56,593,400 | 56,590,723 | -2,677 |
Region | Eligible population | Scenario without B/N combination Budget impact (€) | Scenario with B/N combination Budget impact (€) | Difference (€) with B/N vs. without B/N | ||||||
---|---|---|---|---|---|---|---|---|---|---|
1
st
|
2
nd
|
3
rd
|
1
st
|
2
nd
|
3
rd
|
1
st
|
2
nd
|
3
rd
| ||
Andalucia
|
17,637
| 19,440,146 | 18,100,409 | 17,937,671 | 19,626,710 | 18,223,440 | 18,067,201 | 186,563 | 123,031 | 129,530 |
Aragon
|
1,362
| 1,501,246 | 1,397,786 | 1,385,219 | 1,515,653 | 1,407,287 | 1,395,222 | 14,407 | 9,501 | 10,003 |
Asturias
|
3,289
| 3,625,256 | 3,375,418 | 3,345,070 | 3,660,047 | 3,398,361 | 3,369,225 | 34,791 | 22,943 | 24,155 |
Baleares
|
2,541
| 2,800,783 | 2,607,764 | 2,584,318 | 2,827,662 | 2,625,490 | 2,602,980 | 26,879 | 17,725 | 18,662 |
Canary Islands
|
5,063
| 5,580,624 | 5,196,029 | 5,149,313 | 5,634,180 | 5,231,348 | 5,186,497 | 53,556 | 35,318 | 37,184 |
Cantabria
|
795
| 876,278 | 815,888 | 808,553 | 884,688 | 821,434 | 814,392 | 8,409 | 5,546 | 5,839 |
Castilla La Mancha
|
2,226
| 2,453,579 | 2,284,488 | 2,263,948 | 2,447,125 | 2,300,016 | 2,280,297 | 23,547 | 15,528 | 16,348 |
Castilla León
|
4,197
| 4,626,087 | 4,307,275 | 4,268,549 | 4,670,483 | 4,336,553 | 4,299,373 | 44,396 | 29,277 | 30,824 |
Catalonia
|
7,922
| 8,731,918 | 8,130,149 | 8,057,052 | 8,815,717 | 8,185,411 | 8,115,233 | 83,799 | 55,262 | 58,181 |
Extremadura
|
1,683
| 1,855,064 | 1,727,221 | 1,711,691 | 1,872,867 | 1,738,961 | 1,724,052 | 17,803 | 11,740 | 12,360 |
Galicia
|
7,822
| 8,621,694 | 8,027,522 | 7,955,347 | 8,704,435 | 8,082,086 | 8,012,794 | 82,741 | 54,564 | 57,447 |
Madrid
|
9,606
| 10,588,084 | 9,858,396 | 9,769,761 | 10,689,696 | 9,925,405 | 9,840,309 | 101,612 | 67,009 | 70,549 |
Murcia
|
2,021
| 2,227,620 | 2,074,101 | 2,055,453 | 2,248,998 | 2,088,199 | 2,070,296 | 21,378 | 14,098 | 14,843 |
Navarra
|
799
| 880,687 | 819,994 | 812,621 | 889,139 | 825,567 | 818,489 | 8,452 | 5,574 | 5,868 |
Basque Country
|
2,633
| 2,902,189 | 2,702,182 | 2,677,887 | 2,930,041 | 2,720,549 | 2,697,224 | 27,852 | 18,367 | 19,337 |
La Rioja
|
762
| 839,904 | 782,021 | 774,990 | 847,965 | 787,337 | 780,587 | 8,060 | 5,315 | 5,596 |
Valencia
|
6,425
| 7,081,870 | 6,593,816 | 6,534,532 | 7,149,833 | 6,638,635 | 6,581,718 | 67,963 | 44,819 | 47,187 |
Ceuta
|
603
| 664,649 | 618,844 | 613,280 | 671,027 | 623,050 | 617,708 | 6,379 | 4,206 | 4,429 |
Melilla
|
425
| 468,451 | 436,167 | 432,245 | 472,946 | 439,131 | 435,367 | 4,496 | 2,965 | 3,121 |
Sensitivity analysis
Parameter modified | Value in BC | Value in SA | Scenario without B/N combination | Scenario with B/N combination | Difference (€) with B/N vs. without B/N | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
1
st
year
|
2
nd
year
|
3
rd
year
|
1
st
year
|
2
nd
year
|
3
rd
year
|
1
st
year
|
2
nd
year
|
3
rd
year
| |||
Transition probabilities
| See table 1 | Same values for B/N combination than used for methadone | 1,102 | 1,026 | 1,017 | 1,113 | 1,035 | 1,028 | 10.58 | 9.18 | 11.13 |
B/N combination uptakes
| 10%, 15% and 20% for 1st, 2nd and 3rd year | 0.97%; 2.57% and 3.83% for 1st, 2nd and 3rd year | 1,102 | 1,026 | 1,017 | 1,103 | 1,028 | 1,019 | 1.03 | 1.37 | 1.58 |
Initial proportion of patient distribution
| HTP: 30% and LITP: 70% | HTP: 100% | 1,477 | 1,185 | 1,127 | 1,513 | 1,204 | 1,144 | 35.260 | 19.13 | 16.46 |
LITP: 100% | 941 | 958 | 970 | 941 | 960 | 973 | 0 | 1.76 | 3.44 | ||
Resource cost (cost per minute)
| See table 3 | +10% | 1,201 | 1,126 | 1,116 | 1,218 | 1,129 | 1,119 | 7.78 | 2.87 | 2.30 |
-10% | 995 | 926 | 918 | 1,008 | 937 | 930 | 13.38 | 11.08 | 12.39 |