The costs and consequences of three policy options for reducing heroin dependency.
OBJECTIVE
This study compares the costs and consequences of three interventions for reducing heroin dependency: pharmacotherapy maintenance, residential rehabilitation and prison.


METHODS
Using Australian data, the interventions' cost - consequence ratio was estimated, taking into consideration reduction in heroin use during the intervention; the length of intervention; and post-intervention effects (as measured by abstinence rates). Sensitivity analyses were conducted, including varying the magnitude and duration of treatment effects, and ascribing positive outcomes only to treatment completers. A hybrid model that combined pharmacotherapy maintenance with a prison term was also considered.


RESULTS
If the post-programme abstinence rates are sustained for 2 years, then for an average heroin user the cost of averting a year of heroin use is approximately AUD$5000 for pharmacotherapy maintenance, AUD$11,000 for residential rehabilitation and AUD$52 000 for prison. Varying the parameters does not change the ranking of the programmes. If the completion rate in pharmacotherapy maintenance was raised above 95% (by the threat of prison for non-completers), the combined model of treatment plus prison may become the most cost-effective option.


CONCLUSIONS
Relative performance in terms of costs and consequences is an important consideration in the policy decision-making process, and quantitative data such as those reported herein can provide insights pertinent to evidence-based policy.
Moore
Timothy J
TJ
Turning Point Alcohol and Drug Centre. Fitzroy, VIC, Australia.
Ritter
Alison
A
Caulkins
Jonathan P
JP
D001315:Australia; D003362:Cost-Benefit Analysis; D004335:Drug and Narcotic Control / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*; D006291:Health Policy; D006556:Heroin Dependence / Q000191:economics* / Q000517:prevention & control* / Q000534:rehabilitation; D006801:Humans; D035846:Law Enforcement; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D011330:Prisons / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012114:Residential Treatment / Q000191:economics; D016320:Substance Abuse Treatment Centers / Q000191:economics
D008691:Methadone