Value for money in drug treatment: economic evaluation of prison methadone.
BACKGROUND
Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity of undertaking evaluations in the prison setting. This paper estimates the cost-effectiveness of the New South Wales (NSW) prison methadone program.


METHODS
Information from the NSW prison methadone program was used to construct a model of the costs of the program. The information was combined with data from a randomised controlled trial of provision of prison methadone in NSW. The total program cost was estimated from the perspective of the treatment provider/funder. The cost per heroin free day, compared with no prison methadone, was estimated. Assumptions regarding resource use were tested through sensitivity analysis.


RESULTS
The annual cost of providing prison methadone in NSW was estimated to be 2.9 million Australian dollars (or 3,234 Australian dollars per inmate per year). The incremental cost effectiveness ratio is 38 Australian dollars per additional heroin free day.


CONCLUSIONS
From a treatment perspective, prison methadone is no more costly than community methadone, and provides benefits in terms of reduced heroin use in prisons, with associated reduction in morbidity and mortality.
Warren
Emma
E
Centre for Health Economics Research and Evaluation, CHERE, University of Technology, Sydney, Australia.
Viney
Rosalie
R
Shearer
James
J
Shanahan
Marian
M
Wodak
Alex
A
Dolan
Kate
K
D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000453:epidemiology; D005102:Health Expenditures; D006526:Hepatitis C / Q000453:epidemiology; D006556:Heroin Dependence / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use*; D009294:Narcotics / Q000191:economics* / Q000627:therapeutic use*; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D011330:Prisons / Q000191:economics*; D015819:Substance Abuse, Intravenous / Q000401:mortality; D013997:Time Factors
D009294:Narcotics; D008691:Methadone