Abstract
Opiate dependence imposes a significant economic burden on society in terms of treatment-related costs and prevention services, other healthcare costs, the work absenteeism of patients, productivity loss arising from premature death of patients, costs associated with crime, and social welfare expenditure.
The objective of this research is to review the literature on economic evaluation of treatment of opiate dependence (including detoxification, maintenance and psychosocial support).
A literature review was performed on several electronic databases, including MEDLINE (Ovid), Cochrane Database of Systematic Reviews, NHS Economic Evaluation Library Database (via Cochrane Library), Web of Science, Social Science Citations Index, EMBASE and PsycINFO. A sensitive approach was used in order to maximize the number of articles retrieved; no language or publication year limitations were applied to the searches. A combination of subject heading term searches and natural word searches were used. The Drummond checklist was applied to assess the quality of economic evaluations.
A total of 259 articles were considered relevant, with eight review studies identified. The treatment spectrum ranged from detoxification to maintenance treatments involving the use of agonist and/or antagonist treatments. The evidence suggests that, although the quality of economic evaluations is reasonably good, there is a dearth of knowledge about the cost effectiveness of treatments for opiate dependence. The majority of the literature reporting the results of cost-effectiveness analyses used surrogate outcome measures and adopted a narrow treatment provider perspective. Studies that have conducted cost-benefit analyses, in spite of methodological divergences, generally adopted a societal perspective and consistently demonstrated positive economic returns from opiate treatment. A paucity of research examined the extent to which psychosocial or behavioural interventions support or replace conventional pharmacological approaches.
Economic evaluation provides a useful framework to assist policy makers in allocating resources across competing needs. Opiate dependence is a considerable burden on society’s resources, and treatment provides a cost-beneficial solution to address these consequences. However, to better inform the decision-making process, researchers must continue to produce high-quality, methodological, comparable and scientifically credible economic evaluations.
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References
United Nations Office on Drags and Crime. World drag report. Vienna: UNODC, 2004
Darke S, Ross J. Suicide among heroin users: rates, risk factors and methods. Addiction 2002; 97 (11): 1383–1394
Goldstein A, Herrera J. Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up. Dmg Alcohol Depend 1995; 40 (2): 139–150
Hulse G, English DR, Milne E, et al. The quantification of mortality resulting from the regular use of illicit opiates. Addiction 1999; 94 (2): 221–229
Hall W, Lynskey M, Degenhardt L. Heroin use in Australia [monograph 42]. Sydney: National Drag and Alcohol Research Centre, 1999
European Monitoring Centre for Drags and Drag Addiction (EMCDDA). Annual report on the state of the drags problem in the European Union, 2001. Lisbon: EMCDDA, 2002
UN AIDS (Joint United Nations Programme on HIV/AIDS) and WHO (World Health Organization). AIDS epidemic update December 2001. Geneva: UNAIDS and WHO, 2002
World Health Organization. The world health report 2004. Geneva: WHO, 2004
Single E, Robson L, Xie X, et al. The economic costs of alcohol, tobacco and illicit drags in Canada, 1992. Addiction 1998; 93 (7): 991–1006
Collins DJ, Lapsley HM. Counting the cost: estimates of the social costs of drag abuse in Australia in 1998–99 [National Drag Strategy monograph series no. 49]. Canberra (ACT): Commonwealth of Australia, 2002
Mark T, Woody GE, Juday T, et al. The economic costs of heroin addiction in the United States. Drag Alcohol Depend 2001; 61 (2): 195–206
García-Altés A, Ollé JM, Antoñanzas F, et al. The social cost of illegal drag consumption in Spain. Addiction 2002; 97 (9): 1145–1153
Hammersley R, Forsyth A, Lavelle T. The criminality of new drag users in Glasgow. Br J Addict 1990; 85: 1583–1594
Bell J, Hall W, Byth K. Changes in criminal activity after entering methadone maintenance. Br J Addict 1992; 87: 251–258
Bell J, Mattick R, Hay A, et al. Methadone maintenance and drag-related crime. J Subst Abuse 1997; 9: 15–25
Bennett T, Wright R. The impact of prescribing on the crimes of opioid users. Br J Addict 1986; 81: 265–273
Ball JC, Shaffer JW, Nurco DN. The day-to-day criminality of heroin addicts in Baltimore: a study in the continuity of offence rates. Drag Alcohol Depend 1983; 12 (2): 119–142
Hubbard RL, Marsden ME, Rachal JV, et al. Drag abuse treatment: a national study of effectiveness. London: Chapel Hill, 1989
Rothbard A, Alterman A, Rutherford M, et al. Revisiting the effectiveness of methadone treatment on crime reductions in the 1990s. J Subst Abuse Treat 1999; 16 (4): 329–335
Gossop M, Marsden J, Stewart D, et al. Reductions in acquisitive crime and drag use after treatment of addiction problems: 1-year follow-up outcomes. Drag Alcohol Depend 2000; 58 (1-2): 165–172
Gossop M, Trakada K, Stewart D, et al. Reductions in criminal convictions after addiction treatment: 5-year follow-up. Drag Alcohol Depend 2005; 79 (3): 295–302
World Health Organization. WHO report on neuroscience of psychoactive substance use and dependence. Geneva: WHO, 2005
Amato L, Minozzi S, Davoli M, et al. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev 2004 Oct 18; (4): CD005031
Amato L, Minozzi S, Davoli M, et al. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev 2004 Oct 18; (4): CD004147
Clark N, Lintzeris N, Gijsbers A, et al. LAAM maintenance vs methadone maintenance for heroin dependence. Cochrane Database Syst Rev 2002; (2): CD002210
Gowing L, Ali R, White J. Opioid antagonists with minimal sedation for opioid withdrawal. Cochrane Database Syst Rev 2002; (2): CD002021
Gowing L, Ali R, White J. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev 2002; (2): CD002025
Farrell M, Ward J, Mattick R, et al. Methadone maintenance treatment in opiate dependence: a review. BMJ 1994; 309 (6960): 997–1001
National Institute on Drag Abuse. Report of the Blue Ribbon Task Force on Health Services Research at the National Institute on Drag Abuse. Washington, DC: National Institutes of Health, US Department of Health and Human Services, 2004
Tucker T, Ritter A. Naltrexone in the treatment of heroin dependence: a literature review. Drag and Alcohol Review 2000; 19: 73–82
Mattick RP, Kimber J, Breen C, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2003; (2): CD002207
Cartwright WS. Cost-benefit analysis of drag treatment services: review of the literature. J Ment Health Policy Econ 2000; 3: 11–26
French MT, Drammond MF. A research agenda for economic evaluation of substance abuse services. J Subst Abuse Treat 2005; 29: 125–137
Drammond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 2005
Gold M, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
McCollister KE, French MT. The relative contribution of outcome domains in the total economic benefit of addiction interventions: a review of first findings. Addiction 2003; 98: 1647–1659
French M, Martin R. The costs of drug abuse consequences: a summary of research findings. J Subst Abuse Treat 1996; 13 (6): 453–466
Choi B, Robson L, Single E. Estimating the economic costs of the abuse of tobacco, alcohol and illicit drugs: a review of methodologies and Canadian data sources. Chronic Dis Can 1997; 18 (4): 149–165
Hall W, Doran CM, Degenhardt L, et al. Illicit opioid use. In: Jamison D, Breman J, Measham JG, editors. Disease control priorities in developing countries. New York: Oxford University Press, 2006: 907–932
Simoens S, Ludbrook A, Matheson C, et al. Pharmaco-economics of community maintenance for opiate dependence: a review of evidence and methodology. Drug Alcohol Depend 2006; 84 (1): 28–39
Simoens S, Matheson C, Inkster K, et al. The effectiveness of treatment for drug users: an international systematic review of the evidence. Edinburgh: Scottish Executive Drug Misuse Research Programme, 2002
French M, McGeary K. Estimating the economic cost of substance abuse treatment. Health Econ 1997; 6: 1–6
French M, Dunlap LJ, Zarkin GA, et al. A structured instrument for estimating the economic cost of drug abuse treatment: the Drug Abuse Treatment Cost Analysis Program (DATCAP). J Subst Abuse Treat 1997; 14 (5): 445–455
Bradley CJ, French MT, Rachal JV. Financing and cost of standard and enhanced methadone treatment. J Subst Abuse Treat 1994; 11 (5): 433–442
French MT, Bradley CJ, Calingaert B, et al. Cost analysis of training and employment services in methadone treatment. Eval Program Plann 1994; 17 (2): 107–120
Roebuck C, French MT, McLellan T. DATS tats: results from 85 studies using the Drug Abuse Treatment Cost Analysis Program (DATCAP). J Subst Abuse Treat 2003; 25: 51–57
Alexandre PK, Roebuck MC, French MT, et al. The cost of residential addiction treatment in public housing. J Subst Abuse Treat 2003; 24 (4): 285–290
French MT, Salome HJ, Carney M. Using the DATCAP and ASI to estimate the costs and benefits of residential addiction treatment in the State of Washington (provisional record). Soc Sci Med 2002; 55 (12): 2267–2282
French MT, Salomé HJ, Krupski A, et al. Benefit-cost analysis of residential and outpatient addiction treatment in the State of Washington. Eval Rev 2000; 24 (6): 609–634
Salomé HJ, French MT, Miller M, et al. Estimating the client costs of addiction treatment: first findings from the client drug abuse treatment cost analysis program (client DATCAP). Drug Alcohol Depend 2003; 71 (2): 195–206
Mattick RP, Digiusto E, Doran CM, et al. National evaluation of pharmacotherapies for opioid dependence (NEPOD). Canberra: Commonwealth Department of Health and Ageing, 2001
Shanahan MD, Doran CM, Digiusto E, et al. A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Addict Behav 2006; 31 (3): 371–387
Shepard DS, Larson MJ, Hoffmann NG. Cost-effectiveness of substance abuse services: implications for public policy. Psychiatr Clin North Am 1999; 22 (2): 385–400
Gossop M, Strang J. Price, cost and value of opiate detoxification treatments: reanalysis of data from two randomised trials. Br J Psychiatry 2000; 177: 262–266
De Jong C, Laheij R, Krabbe P, et al. General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial. Addiction 2005; 100 (2): 206–215
Doran CM, Shanahan M, Bell J, et al. A cost-effectiveness analysis of buprenorphine-assisted heroin withdrawal. Drug Alcohol Rev 2004; 23 (2): 171–175
Hartz DT, Meek P, Piotrowski NA, et al. A cost-effectiveness and cost-benefit analysis of contingency contracting-enhanced methadone detoxification treatment. Am J Drug Alcohol Abuse 1999; 25 (2): 207–218
Masson C, Barnett PG, Sees KL, et al. Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification. Addiction 2004; 99 (6): 718–726
Doran CM, Shanahan M, Digiusto E, et al. A cost-effectiveness analysis of maintenance agonist treatments in the National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Exp Rev Pharmacoeconomics Outcomes Res 2006; 6 (4): 437–446
Barnett PG. The cost-effectiveness of methadone maintenance as a health care intervention. Addiction 1999; 94 (4): 479–488
Zaric GS, Barnett PG, Brandeau ML. HIV transmission and the cost-effectiveness of methadone maintenance. Am J Public Health 2000; 90 (7): 1100–1111
Strang J, Marsden J, Cummins M, et al. Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome. Addiction 2000; 95 (11): 1631–1645
Kraft M, Rothbard AB, Hadley TR, et al. Are supplementary services provided during methadone maintenance really cost-effective? Am J Psychiatry 1997; 154 (9): 1214–1219
Avants SK, Margolin A, Sindelar JL, et al. Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. Am J Psychiatry 1999; 156 (1): 27–33
Sigmon SC, Stitzer ML. Use of low-cost incentive intervention to improve counseling attendance among methadone maintained patients. J Subst Abuse Treat 2005; 29 (4): 253–258
Warren E, Viney R, Shearer J, et al. Value for money in drug treatment: economic evaluation of prison methadone. Drug Alcohol Depend 2006; 84 (2): 160–166
Dolan K, Shearer J, Macdonald M, et al. A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Drug Alcohol Depend 2003; 72: 59–65
Barnett PG, Zaric GS, Brandeau ML. The cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States. Addiction 2001; 96: 1267–1278
Doran CM, Shanahan M, Mattick RP, et al. Buprenorphine versus methadone maintenance: a cost-effectiveness analysis. Drug Alcohol Depend 2003; 71 (3): 295–302
Harris AH, Gospodarevskaya E, Ritter AJ. A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting. Pharmacoeconomics 2005; 23 (1): 77–91
Dijkgraaf MG, van der Zanden BP, de Borgie CA, et al. Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials. BMJ 2005; 330 (7503): 1297–1302
Mojtabai R, Zivin JG. Effectiveness and cost-effectiveness of four treatment modalities for substance disorders: a propensity score analysis (provisional record). Health Serv Res 2003; 38 (1): 233–259
Hubbard RL, Rachal JV, Craddock SG. Treatment Outcome Prospective Study (TOPS): client characteristics and behaviors before, during, and after treatment. In: Tims FM, Ludford JP, editors. Drug abuse treatment evaluation: strategies, progress, and prospects [National Institute on Drug Abuse Research monograph no. 51; DHHS publication no. (ADM) 84-1329]. Washington, DC: US Government Print Office, 1984
Mauser E, Van Stelle KR, Moberg DP. The economic impact of diverting substance-abusing offenders into treatment. Crime Delinq 1994; 40 (4): 568–588
The California Dmg and Alcohol Treatment Assessment (CALDATA) general report. Sacramento (CA): State of California, Department of Alcohol and Drug Programs, 1994
Hser Y, Teruya E, Hardy M, et al. The California Treatment Outcome Project (CalTOP) final report submitted to the California Department of Alcohol and Drug Programs. Los Angeles (CA): UCLA Integrated Substance Abuse Programs, 2002
Gossop M, Marsden J, Stewart D, et al. Substance use, health and social problems of service users at 54 drug treatment agencies: intake data from the National Treatment Outcome Research Study. Br J Psychiatry 1998; 173: 166–171
Harwood H, Hubbard RL, Collins JJ, et al. The costs of crime and the benefits of drug abuse treatment: a cost-benefit analysis using TOPS data, in compulsory treatment of drug abuse. Research and clinical practice. Rockville (MD): US Department of Health and Human Services, National Institutes of Health, 1998
Harwood HJ, Napolitano DM, Kristiansen PL, et al. Economic costs to society of alcohol and drug abuse and mental illness. Research Triangle Park (NC): Research Triangle Institute, 1984
Rajkumar AS, French MT. Drug use, crime costs, and the economic benefits of treatment. J Quantitative Criminol 1997; 13: 291–323
Gerstein DR, Johnson RA, Harwood H, et al. Evaluating recovery services: the California drug and alcohol treatment system (CALDATA). Sacramento (CA): California Department of Alcohol and Drug Programs, 1994
Ettner SL, Huang DH, Rose D, et al. Benefit-cost in the California treatment outcome project: does substance abuse treatment “pay for itself”? Health Serv Res 2006; 41 (1): 192–213
Godfrey C, Stewart D, Gossop M. Economic analysis of costs and consequences of the treatment of dmg misuse: 2-year outcome data from the National Treatment Outcome Research Study (NTORS). Addiction 2004; 99 (6): 697–707
Gossop M, Marsden J, Stewart D. NTORS at one year: changes in substance use, health and criminal behaviour one year after intake. London: Department of Health, 1998
Gossop M, Marsden J, Stewart D, et al. The National Treatment Outcome Research Study in the United Kingdom: six month follow-up outcomes. Psychol Addict Behav 1997; 11: 324–337
Gossop M, Marsden J, Stewart D, et al. Outcomes after methadone maintenance reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Depend 2001; 62: 255–264
French MT, Salome HJ, Carney M. Benefit-cost analysis of addiction treatment in Arkansas: specialty and standard residential programs for pregnant and parenting women. Soc Sci Med 2002; 55 (12): 2267–2282
Daley M, Argeriou M, McCarty D, et al. The costs of crime and the benefits of substance abuse treatment for pregnant women. J Subst Abuse Treat 2000; 19 (4): 445–458
Fals-Stewart W, Birchler GR, O’Farrell TJ. Behavioral couples therapy for male substance-abusing patients: effects on relationship adjustment and drug-using behavior J Consult Clin Psychol 1996; 64: 959–972
Fals-Stewart W, O’Farrell TJ, Birchler GR. Behavioral couples therapy for male substance-abusing patients: a cost outcomes analysis. J Consult Clin Psychol 1997; 65: 789–802
Koenig L, Siegel JM, Harwood H, et al. Economic benefits of substance abuse treatment: findings from Cuyahoga County, Ohio. J Subst Abuse Treat 2005; 28: S41–S50
Acknowledgements
No sources of funding were used to assist in the preparation of this review other than normal salary paid by the University of Queensland. The author has no conflicts of interest that are directly relevant to the content of this review. The views expressed in this paper are those of the author only and as such the author accepts full responsibility for any errors or inaccuracies that may remain. Adrian Carter provided research assistance. The author is grateful for comments made by two anonymous reviewers and the editor.
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Doran, C.M. Economic Evaluation of Interventions to Treat Opiate Dependence. Pharmacoeconomics 26, 371–393 (2008). https://doi.org/10.2165/00019053-200826050-00003
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DOI: https://doi.org/10.2165/00019053-200826050-00003