Impact of methadone maintenance on health utility, health care utilization and expenditure in drug users with HIV/AIDS.
BACKGROUND
This study assessed the impact of methadone maintenance treatment (MMT) on health utility, health care service utilization, and out-of-pocket (OOP) health expenditure in drug users with HIV/AIDS in Vietnam.


METHODS
Using the 2012 Vietnam HIV Service Users Survey data, a post-evaluation was designed to compare 121 MMT patients with 347 non-MMT patients who were matched using propensity scores of MMT covariates. Health utility was measured using the EuroQOL - five dimensions - five levels (EQ-5D-5L) and a visual analogue scale (EQ-VAS).


RESULTS
The mean EQ-5D-5L single index and EQ-VAS score of MMT patients were 0.68 (95% CI=0.64-0.73) and 71.5% (95% CI=68.2-74.9). Compared with the control group, the adjusted differences in health utility were 0.08 and 4.43% (p=0.07), equivalent to 12.1% and 6.5% increases during MMT. There was a 45.9% decrease in the frequency of health care service utilization that was attributable to MMT. Although, antiretroviral treatment and MMT services were free-of-charge, MMT and non-MMT patients still paid their OOP for health care for averagely US$ 16.3/month and US$ 28.9/month. The adjusted difference between the two groups was US$ 19.3/month ($ 231.6/year) that equivalents to a reduction of 66.7% in OOP health expenditure related to MMT.


CONCLUSIONS
MMT was associated with a clinically important difference in health utility, large reductions in health care service utilization and OOP health expenditure in HIV-positive drug users. Scaling up MMT in large drug-using population could help improve the outcomes of HIV/AIDS interventions and reduce economic vulnerability of affected households.
Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Electronic address: bach@hmu.edu.vn.
Bach Xuan
BX
Tran
Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Viet Nam.
Long Thanh
LT
Nguyen
D000328:Adult; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006556:Heroin Dependence / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D015397:Program Evaluation; D057216:Propensity Score; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014744:Vietnam / Q000453:epidemiology; D035862:Vulnerable Populations
D000701:Analgesics, Opioid; D008691:Methadone
Drug users; HIV/AIDS; Health care utilization; Methadone maintenance; Out-of-pocket; Vietnam