Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification.
OBJECTIVE
To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services.


METHODS
Randomized controlled study conducted from May 1995 to April 1999.


METHODS
Research clinic in an established drug treatment program.


METHODS
One hundred and seventy-nine adults with diagnosed opioid dependence. Intervention Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n = 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months.


METHODS
Total health-care costs and self-reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Findings Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($7564 versus $6687; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions.


CONCLUSIONS
Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction.
Masson
Carmen L
CL
University of California, San Francisco, USA. masson@itsa.ucsf.edu
Barnett
Paul G
PG
Sees
Karen L
KL
Delucchi
Kevin L
KL
Rosen
Amy
A
Wong
Wynnie
W
Hall
Sharon M
SM
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use; D009294:Narcotics / Q000191:economics* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone