ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2012
Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
56 citing papers in PubMed, 8 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review.Harm reduction journal · 2022Pooled it
- A Systematic Review of Simulation Models to Track and Address the Opioid Crisis.Epidemiologic reviews · 2022Pooled it
- Economic Evaluation in Opioid Modeling: Systematic Review.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2021Pooled it
- Economic Evaluations of Opioid Use Disorder Interventions.PharmacoEconomics · 2016Pooled it
- A systematic review of modelling approaches in economic evaluations of health interventions for drug and alcohol problems.BMC health services research · 2016Pooled it
- The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review.PharmacoEconomics · 2013Pooled it
- Guideline
- Characterizing the subjective, observer-rated, and physiological effects of hydromorphone relative to heroin in a human laboratory study.Psychopharmacology · 2018Trial
- Trial
- Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing Communities Study.Lancet regional health. Americas · 2026Article
- Impact of enhanced practices on opioid overdose deaths: A community-based modeling approach.Addiction (Abingdon, England) · 2026Article
- Article
- Population-Level Health Benefits and Harms Associated With Buprenorphine/Naloxone vs Methadone.JAMA network open · 2025Article
- Challenges for the implementation of injectable opioid agonist treatment: a scoping review.Harm reduction journal · 2024Article
- Informing evidence-based medicine for opioid use disorder using pharmacoeconomic studies.Expert review of pharmacoeconomics & outcomes research · 2024Review
- Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study.BMJ (Clinical research ed.) · 2024Article
- "It feels like I'm coming to a friend's house": an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre).Addiction science & clinical practice · 2023Article
- Changes in daily dose in open-label compared to double-blind: The role of clients' expectations in injectable opioid agonist treatment.Addictive behaviors reports · 2023Article
- Article
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9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAlthough diacetylmorphine has been proven to be more effective than methadone maintenance treatment for opioid dependence, its direct costs are higher. We compared the cost-effectiveness of diacetylmorphine and methadone maintenance treatment for chronic opioid dependence refractory to treatment.
methodsWe constructed a semi-Markov cohort model using data from the North American Opiate Medication Initiative trial, supplemented with administrative data for the province of British Columbia and other published data, to capture the chronic, recurrent nature of opioid dependence. We calculated incremental cost-effectiveness ratios to compare diacetylmorphine and methadone over 1-, 5-, 10-year and lifetime horizons.
resultsDiacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each of the time horizons. Over a lifetime horizon, our model showed that people receiving methadone gained 7.46 discounted quality-adjusted life-years (QALYs) on average (95% credibility interval [CI] 6.91-8.01) and generated a societal cost of $1.14 million (95% CI $736,800-$1.78 million). Those who received diacetylmorphine gained 7.92 discounted QALYs on average (95% CI 7.32-8.53) and generated a societal cost of $1.10 million (95% CI $724,100-$1.71 million). Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity. Probabilistic sensitivity analysis showed that the probability of diacetylmorphine being cost-effective at a willingness-to-pay threshold of $0 per QALY gained was 76%; the probability was 95% at a threshold of $100,000 per QALY gained. Results were confirmed over a range of sensitivity analyses.
interpretationUsing mathematical modelling to extrapolate results from the North American Opiate Medication Initiative, we found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.