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

The within-trial analysis found hydromorphone provided similar QALYs to diacetylmorphine [0.377, 95% confidence interval (CI) = 0.361–0.393 versus 0.375, 95% CI = 0.357–0.391], but accumulated marginally greater costs [$49 830 ($28 401–73 637) versus $34 320 ($21 780–55 998)]. The life-time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone [8.4 (7.4–9.5) and 8.3 (7.2–9.5) versus 7.4 (6.5–8.3) QALYs] at lower cost [$1.01 million ($0.6–1.59 million) and $1.02 million ($0.72–1.51 million) versus $1.15 million ($0.71–1.84 million)]. 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.