title: Subsidising patient dispensing fees: the cost of injecting equity into the opioid pharmacotherapy maintenance system.
abstract: OBJECTIVE
  Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health-care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees.
  
  
  METHODS
  A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios.
  
  
  RESULTS
  Current modelled costs (AUS$11.73m per month) were largely borne by state/territory government (43%), with patients bearing one-third (33%) of the total costs and the Commonwealth one-quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $81.8m to $175.8m.
  
  
  CONCLUSIONS
  If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program.
authors.affiliation: Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. j.chalmers@unsw.edu.au
authors.forename: Jenny
authors.initials: J
authors.lastname: Chalmers
authors.forename: Alison
authors.initials: A
authors.lastname: Ritter
mesh_terms: D001315:Australia; D003365:Costs and Cost Analysis; D005380:Financing, Government / Q000191:economics*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000191:economics*; D018803:Models, Economic; D058850:Opiate Substitution Treatment / Q000191:economics*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics; D010349:Patient Compliance; D011306:Prescription Fees
chemical_list: D008691:Methadone