title: Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost-effectiveness analysis.
abstract: OBJECTIVE
  To determine the success threshold at which a theoretical course of deep brain stimulation (DBS) would provide the same quality of life (QoL) and cost-effectiveness for heroin dependence as methadone maintenance treatment (MMT).
  
  
  METHODS
  We constructed a decision analysis model to calculate QoL after 6 months of MMT and compared it to a theoretical course of DBS. We also performed a cost-effectiveness analysis using societal costs of heroin dependence, MMT and DBS.
  
  
  METHODS
  Systematic literature review and meta-analysis.
  
  
  METHODS
  Patients (n = 1191) from 15 trials administering 6 months of MMT and patients (n = 2937) from 45 trials of DBS for movement disorders.
  
  
  METHODS
  Data on QoL before and after MMT, retention in MMT at 6 months, as well as complications of DBS and their impact on QoL in movement disorders.
  
  
  RESULTS
  We found a QoL of 0.633 (perfect health = 1) in heroin addicts initiating MMT. Sixty-six per cent of patients completed MMT, but only 47% of them had opiate-free urine samples, resulting in an average QoL of 0.7148 (0.3574 quality-adjusted life years (QALYs) over 6 months). A trial of DBS is less expensive ($81,000) than untreated (or relapsed) heroin dependence ($100,000), but more expensive than MMT ($58,000). A theoretical course of DBS would need a success rate of 36.5% to match MMT, but a success rate of 49% to be cost-effective.
  
  
  CONCLUSIONS
  The success rate, defined as the percentage of patients remaining heroin-free after 6 months of treatment, at which deep brain stimulation would be similarly cost-effective in treating opiate addiction to methadone maintenance treatment, is estimated at 49%.
authors.affiliation: Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Stephen
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
authors.forename: Cristian J
authors.initials: CJ
authors.lastname: Barrios
authors.forename: Usha
authors.initials: U
authors.lastname: Balmuri
authors.forename: Jared M
authors.initials: JM
authors.lastname: Pisapia
authors.forename: John A
authors.initials: JA
authors.lastname: Wolf
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Kampman
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Baltuch
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D046690:Deep Brain Stimulation / Q000191:economics / Q000379:methods*; D006556:Heroin Dependence / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D009294:Narcotics; D008691:Methadone