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RTI Author Awards Series
Benefits and Costs of Methadone Treatm ent: Results from a Lifetim e
Sim ulation Model
Zarkin, G.A., Dunlap, L.J., Hicks, K.A., & Mamo, D. (2005).
Benefits and costs of methadone treatment: Results from a lifetime
simulation model. Health Economics 14 (11):1133-1150.
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. The model captures essential features of the dynamics of
heroin use and methadone treatment and the associated social consequences of heroin use
that generate pressure on policy makers to reduce the harm from illegal drugs. This is the
first study to present estimates of the lifetime benefits and costs associated with drug use
and its treatment.
Gary Zarkin Laura Dunlap
Our model represents the progression of individuals from the general population aged 18
to 60 with respect to their heroin use, methadone treatment for heroin use, criminal
behavior, employment, and health care use. We also present three model scenarios to
evaluate how changes in treatment parameters affect model results—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. The model provides a rich characterization of the dynamics of heroin use and
captures the notion of heroin use as a chronic recurring condition.
The benefit-cost ratio of treatment from our lifetime model (37.72) exceeds the benefit-cost ratio from a single
treatment episode (4.86) based on a static analysis. The magnitude of the lifetime model illustrates that
treatment has a multiplicative effect that arises because treatment changes an individual’s life trajectory by
changing the individual’s propensity to use drugs, which in turn affects future employment opportunities and
the propensity to commit future crime and seek health care.