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The Study to Assess Long\u2010term Opioid Maintenance Effectiveness (SALOME) randomized controlled trial provided evidence that injectable hydromorphone is non\u2010inferior to diacetylmorphine. The current study aimed to compare the cost\u2010effectiveness of hydromorphone directly with diacetylmorphine and indirectly with methadone maintenance treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A within\u2010trial analysis was conducted using the patient level data from the 6\u2010month, double\u2010blind, non\u2010inferiority SALOME trial. A life\u2010time analysis extrapolated costs and outcomes using a decision analytical cohort model. The model incorporated data from a previous trial to include an indirect comparison to methadone maintenance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A supervised clinic in Vancouver, British Columbia, Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 202 long\u2010term street opioid injectors who had at least two attempts at treatment, including one with methadone (or other substitution), were randomized to hydromorphone (<jats:italic>n<\/jats:italic>\u00a0=\u00a0100) or diacetylmorphine (<jats:italic>n<\/jats:italic>\u00a0=\u00a0102).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>We measured the utilization of drugs, visits to health professionals, hospitalizations, criminal activity, mortality and quality of life. This enabled us to estimate incremental costs, quality\u2010adjusted life years (QALYs) and cost\u2010effectiveness ratios from a societal perspective. Sensitivity analyses considered different sources of evidence, assumptions and perspectives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The within\u2010trial analysis found hydromorphone provided similar QALYs to diacetylmorphine [0.377, 95% confidence interval (CI)\u00a0=\u00a00.361\u20130.393 versus 0.375, 95% CI\u00a0=\u00a00.357\u20130.391], but accumulated marginally greater costs [$49\u2009830 ($28\u2009401\u201373\u2009637) versus $34\u2009320 ($21\u2009780\u201355\u2009998)]. The life\u2010time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone [8.4 (7.4\u20139.5) and 8.3 (7.2\u20139.5) versus 7.4 (6.5\u20138.3) QALYs] at lower cost [$1.01\u00a0million ($0.6\u20131.59\u00a0million) and $1.02\u00a0million ($0.72\u20131.51\u00a0million) versus $1.15\u00a0million ($0.71\u20131.84\u00a0million)].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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\u2010time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost\u2010saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14171","type":"journal-article","created":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T14:27:21Z","timestamp":1522247241000},"page":"1264-1273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Cost\u2010effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1510-3462","authenticated-orcid":false,"given":"Nick","family":"Bansback","sequence":"first","affiliation":[{"name":"Centre for Health Evaluation and Outcome Sciences Providence Health Care, St Paul's Hospital  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