title: A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence.
abstract: OBJECTIVE
  Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post-release.
  
  
  METHODS
  Population-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011).
  
  
  METHODS
  New South Wales, Australia.
  
  
  METHODS
  A cohort of 16,073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011.
  
  
  METHODS
  OST treatment compared to no OST treatment at prison release.
  
  
  METHODS
  Mortality and costs (treatment, criminal justice system-court, penalties, prison-and the social costs of crime) were evaluated at 6 months post-release. Analyses included propensity score matching, bootstrapping and regression.
  
  
  RESULTS
  A total of 13,468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14,356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.
  
  
  CONCLUSIONS
  Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6 months of release.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Gisev
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Marian
authors.initials: M
authors.lastname: Shanahan
authors.affiliation: New South Wales Bureau of Crime Statistics and Research (BOCSAR), Sydney, New South Wales, Australia.
authors.forename: Don J
authors.initials: DJ
authors.lastname: Weatherburn
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.|Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Burns
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.|School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Louisa
authors.identifier: http://orcid.org/0000-0002-8513-2218
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000328:Adult; D017668:Age of Onset; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003688:Deinstitutionalization / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use; D009517:New South Wales / Q000453:epidemiology; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000401:mortality; D009293:Opioid-Related Disorders / Q000191:economics* / Q000401:mortality / Q000534:rehabilitation; D011329:Prisoners / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone
keywords: Cost-effectiveness; data linkage; mortality; opioid substitution treatment; opioid-related disorders; prisons