title: Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction.
abstract: BACKGROUND
  Despite evidence of the effectiveness of injectable opioid treatment compared with oral methadone for chronic heroin addiction, the additional cost of injectable treatment is considerable, and cost-effectiveness uncertain.
  
  
  OBJECTIVE
  To compare the cost-effectiveness of supervised injectable heroin and injectable methadone with optimised oral methadone for chronic refractory heroin addiction.
  
  
  METHODS
  Multisite, open-label, randomised controlled trial. Outcomes were assessed in terms of quality-adjusted life-years (QALYs). Economic perspective included health, social services and criminal justice resources.
  
  
  RESULTS
  Intervention costs over 26 weeks were significantly higher for injectable heroin (mean £8995 v. £4674 injectable methadone and £2596 oral methadone; P<0.0001). Costs overall were highest for oral methadone (mean £15 805 v. £13 410 injectable methadone and £10 945 injectable heroin; P = n.s.) due to higher costs of criminal activity. In cost-effectiveness analysis, oral methadone was dominated by injectable heroin and injectable methadone (more expensive and less effective). At willingness to pay of £30 000 per QALY, there is a higher probability of injectable methadone being more cost-effective (80%) than injectable heroin.
  
  
  CONCLUSIONS
  Injectable opioid treatments are more cost-effective than optimised oral methadone for chronic refractory heroin addiction. The choice between supervised injectable heroin and injectable methadone is less clear. There is currently evidence to suggest superior effectiveness of injectable heroin but at a cost that policy makers may find unacceptable. Future research should consider the use of decision analytic techniques to model expected costs and benefits of the treatments over the longer term.
authors.affiliation: Sarah Byford, PhD, Barbara Barrett, PhD, Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, UK; Nicola Metrebian, PhD, Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, UK; Teodora Groshkova, PhD, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal; Maria Cary, MSc, Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, UK; Vikki Charles, MA, Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, UK; Nicholas Lintzeris, PhD, The Langton Centre, South Eastern Sydney Local Health District, NSW Health, Australia; John Strang, MD, Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.forename: Nicola
authors.initials: N
authors.lastname: Metrebian
authors.forename: Teodora
authors.initials: T
authors.lastname: Groshkova
authors.forename: Maria
authors.initials: M
authors.lastname: Cary
authors.forename: Vikki
authors.initials: V
authors.lastname: Charles
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: John
authors.initials: J
authors.lastname: Strang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics*; D002908:Chronic Disease; D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003415:Crime / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D003932:Heroin / Q000008:administration & dosage / Q000191:economics*; D006556:Heroin Dependence / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D007267:Injections / Q000191:economics; D057194:Intention to Treat Analysis; D008691:Methadone / Q000008:administration & dosage / Q000191:economics*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin; D008691:Methadone