title: Cost-effectiveness of methadone maintenance treatment for HIV-positive drug users in Vietnam.
abstract: Methadone maintenance treatment (MMT) is efficacious in reducing drug use that may improve HIV/AIDS care and treatment outcomes. This study evaluated the incremental cost-effectiveness of MMT for HIV-positive drug users from the perspective of health service providers. A sample of 370 HIV-positive drug users (age: mean ± SD: 29.5 ± 5.9 years; 95.7% male) taking MMT in multi-sites was assessed at baseline, three, six and nine months. Costs of MMT services were analyzed and converted to the year 2009. Quality-adjusted life years (QALYs) were modeled from changes in health-related quality of life of patients using the modified World Health Organization Quality of Life - Brief Version (WHOQOL-BREF). Inverse probability-of-treatment weights, constructed using propensity score of non-responses, were applied to adjust for potential confounding. Over nine months, MMT substantially improved QALYs of HIV/AIDS patients (0.076 QALY [0.066-0.084]). The increments in QALY were large and stabilized in those patients taking antiretroviral treatment and abstinent to drug use. For one QALY gained, the MMT program would cost US$3745.3, approximately 3.2 times Vietnam GDP per capita in 2009. The cost-effectiveness of MMT intervention was robust against HIV advanced status or co-morbidity, e.g., TB treatment, but it might not be cost-effective for those patients who continued to use drug. Findings of this study indicate that providing MMT for HIV-positive drug users is a cost-effective intervention in Vietnam. Integrating MMT to HIV/AIDS care and treatment services would be beneficial in injection-driven HIV epidemics.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Canada. bach.tran@ualberta.ca
authors.forename: Bach Xuan
authors.initials: BX
authors.lastname: Tran
authors.forename: Arto
authors.initials: A
authors.lastname: Ohinmaa
authors.forename: Anh Thuy
authors.initials: AT
authors.lastname: Duong
authors.forename: Nhan Thi
authors.initials: NT
authors.lastname: Do
authors.forename: Long Thanh
authors.initials: LT
authors.lastname: Nguyen
authors.forename: Steve
authors.initials: S
authors.lastname: Mills
authors.forename: Stan
authors.initials: S
authors.lastname: Houston
authors.forename: Philip
authors.initials: P
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015819:Substance Abuse, Intravenous / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome; D014744:Vietnam; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone