Article

Benefits and costs of methadone treatment: Results from a lifetime simulation model

RTI International, Research Triangle Park, NC 27709, USA.
Health Economics (Impact Factor: 2.14). 11/2005; 14(11):1133-50. DOI: 10.1002/hec.999
Source: PubMed

ABSTRACT Several studies have examined the benefits and costs of drug treatment; however, they have typically focused on the benefits and costs of a single treatment episode. Although beneficial for certain analyses, the results are limited because they implicitly treat drug abuse as an acute problem that can be treated in one episode. We developed a Monte Carlo simulation model that incorporates the chronic nature of drug abuse. Our model represents the progression of individuals from the general population aged 18-60 with respect to their heroin use, treatment for heroin use, criminal behavior, employment, and health care use. We also present three model scenarios representing an increase in the probability of going to treatment, an increase in the treatment length of stay, and a scenario in which drug treatment is not available to evaluate how changes in treatment parameters affect model results. We find that the benefit-cost ratio of treatment from our lifetime model (37.72) exceeds the benefit-cost ratio from a static model (4.86). The model provides a rich characterization of the dynamics of heroin use and captures the notion of heroin use as a chronic recurring condition. Similar models can be developed for other chronic diseases, such as diabetes, mental illness, or cardiovascular disease.

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    • "In addition to increasing the evidence base for the cost-effectiveness of CM in general, to our knowledge this is the first study to shed light on the relative cost-effectiveness of prize CM vs. voucher CM. This study also adds to the growing literature on the costeffectiveness of well-defined empirically validated treatments and interventions for substance use disorder (Barnett et al., 2001; Cartwright, 1998, 2000; French et al., 1996; Olmstead et al., 2007a, 2007b; Sindelar et al., 2007a, 2007b; Zarkin et al., 2005). "
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    ABSTRACT: To evaluate the cost-effectiveness of using prize-based and voucher-based contingency management (CM) as additions to standard treatment for cocaine- or heroin-dependent outpatients in community treatment centers. This cost-effectiveness analysis is based on a randomized clinical trial conducted at three community-based outpatient psychosocial substance abuse treatment clinics. A total of 142 cocaine- or heroin-dependent outpatients were randomly assigned to one of three treatment conditions: standard treatment (ST), ST with prizes (prize CM), or ST with vouchers (voucher CM) for 12 weeks. The primary patient outcome was the longest duration of confirmed abstinence (LDA) from cocaine, opioids and alcohol during treatment. Unit costs were collected from the three participating clinics. Resource utilizations and patient outcomes were obtained from the clinical trial. Incremental cost-effectiveness ratios (ICERs) and acceptability curves were used to evaluate the relative cost-effectiveness of the interventions. Based on the ICERs and acceptability curves, ST is likely to be the most cost-effective intervention when the threshold value to decision makers of lengthening the LDA during treatment by 1 week is less than approximately $166, and prize CM is likely to be the most cost-effective intervention when the threshold value is greater than approximately $166. Prize CM was found likely to be the most cost-effective intervention over a comparatively wide range of threshold values for lengthening the LDA during treatment by 1 week. However, additional studies with alternative incentive parameters are required to determine the generalizability of our results.
    Drug and alcohol dependence 04/2009; 102(1-3):108-15. DOI:10.1016/j.drugalcdep.2009.02.005 · 3.28 Impact Factor
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    • "account the lifetime impact of criminal activity and potential incarceration, unemployment , heath care utilization, and the possible need for multiple treatment episodes –– found an economic benefit-to-cost ratio for methadone maintenance of nearly $38 for every $1 spent on this treatment (see Graph); more than a 9-fold greater return on investment in treatment than previously projected (Zarkin et al. 2005). "
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