HIV transmission and the cost-effectiveness of methadone maintenance.
OBJECTIVE
This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic.


METHODS
We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%.


RESULTS
Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots.


CONCLUSIONS
Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.
Zaric
G S
GS
Cooperative Studies Program, Palo Alto Veterans Affairs Health Care System, Menlo Park, Calif. 94025, USA.
Barnett
P G
PG
Brandeau
M L
ML
D000328:Adult; D000701:Analgesics, Opioid / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D017048:Health Care Costs; D006556:Heroin Dependence / Q000534:rehabilitation* / Q000821:virology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D008962:Models, Theoretical; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation* / Q000821:virology; D015996:Survival Rate
D000701:Analgesics, Opioid; D008691:Methadone