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

RTI International, Research Triangle Park, NC 27709, USA.
Health Economics (Impact Factor: 2.23). 11/2005; 14(11):1133-50. DOI: 10.1002/hec.999
Source: PubMed


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. Copyright

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    • "First conceived as a therapeutic response that was limited in time and ended with a withdrawal from methadone [5], OSTM progressively evolved towards maintenance treatments that are considered necessary over the long-term (methadone maintenance treatments, MMT) [6]. The current representation of drug dependence is that of a chronic disease with repeated phases of consumption, abstinence, and treatment [7]. Periods of abstinence are mostly short [8,9] and are often followed by relapse [10]. "
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    ABSTRACT: Background To determine, in a region of Switzerland, the duration of retention in opioid substitution treatments with methadone (OSTM), duration of treatment interruptions, probability of re-entry to treatment after a treatment interruption, and associated factors. Methods A secondary analysis of registry-based data was performed with patients (n = 2880) registered in the methadone treatment register database of the Public Health Service of the canton of Vaud between January 1, 2001 and June 30, 2008. Survival analysis and multivariate analysis was conducted. Results The probability of remaining on treatment was 69% at 1 year and 45% at 3 years (n =1666). One-third of patients remained on treatment beyond 5 years. The estimated hazard of leaving treatment was increased by a ratio of 1.31 in the case of a first treatment (P = 0.001), 1.83 for those without a fixed home (P < 0.001), and 1.29 for those younger than 30 years old (P < 0.001). The probability of having begun a new treatment after a first interruption was 21% at one year, 38% at 3 years, and 43% at 5 years (n = 1581). Factors at the interruption of treatment associated with a higher probability of re-entering were: interruption not due to methadone withdrawal, bad physical health, and higher methadone dose. Conclusions OSTM are long-term (maintenance) treatments in Switzerland. Younger age, bad living conditions at entry, and first treatment are predictors of lower retention. Approximately one-half of patients who interrupt treatment will re-enter treatment within 5 years.
    Full-text · Article · Dec 2012 · BMC Psychiatry
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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.
    Preview · Article · Apr 2009 · Drug and alcohol dependence
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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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