Cost-effectiveness of center-based compulsory rehabilitation compared to community-based voluntary methadone maintenance treatment in Hai Phong City, Vietnam.
In Vietnam, two dominant approaches for heroin treatment are center-based compulsory rehabilitation (CCT), funded by the Vietnamese government and community-based voluntary methadone maintenance treatment (MMT), funded primarily by international donors. Recent reduction in international funding requires more efficient allocation of government funding for public health programs. A cost-effectiveness analysis comparing two approaches provides a useful source of evidence to inform the government about funding reallocation.



The study was a combined retrospective and prospective, non-randomized cohort comparison over three years of CCT and MMT in Vietnam, conducted between 2012 and 2014, involving 208 CCT participants and 384 MMT participants with heroin dependence. The primary end-point was drug-free days over three years. Total costs, including both program and participant personal costs were measured and cost-effectiveness compared. Mixed effects regression analyses were used to analyze effectiveness data and non-parametric bootstrapping method was used to compare cost-effectiveness.



Over three years, MMT costed on average VND85.73 million (US$4108) less than CCT (95% CI: -VND76.88 million, -VND94.59 million). On average, a MMT participant had 344.20 more drug-free days compared to a CCT participant (p<0.001). The incremental cost-effectiveness ratio for MMT was -VND0.25 million (US$11.99) (95% CI: -VND0.34 million, -VND0.19 million) per drug-free day suggesting MMT is the more cost effective alternative.



Compared to CCT, MMT is both less expensive and more effective in achieving drug-free days. If the government of Vietnam invests in MMT instead of CCT, it is potentially a cost-saving strategy for reducing illicit drug use among heroin dependent individuals.
National Drug and Alcohol Research Centre/UNSW, Australia. Electronic address: thu.vuong@unsw.edu.au.
Thu
T
Vuong
National Drug and Alcohol Research Centre/UNSW, Australia.
Marian
M
Shanahan
FHI360, Viet Nam.
Nhu
N
Nguyen
Hanoi Medical University, Viet Nam.
Giang
G
Le
National Drug and Alcohol Research Centre/UNSW, Australia; University of Adelaide, Australia.
Robert
R
Ali
Haiphong University of Medicine and Pharmacy, Viet Nam.
Khue
K
Pham
FHI360, Viet Nam.
Thu T A
TTA
Vuong
Hanoi Medical University, Viet Nam.
Thuy
T
Dinh
National Drug and Alcohol Research Centre/UNSW, Australia.
Alison
A
Ritter
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006556:Heroin Dependence / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000191:economics* / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics*; D011446:Prospective Studies; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000191:economics*; D016896:Treatment Outcome; D014744:Vietnam
D009294:Narcotics; D008691:Methadone
Compulsory rehabilitation; Cost-effectiveness; East and Southeast Asia; Economic evaluation; Heroin dependence; Methadone treatment