title: Implementation of methadone therapy for opioid use disorder in Russia - a modeled cost-effectiveness analysis.
abstract: Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD.
  
  
  
  We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%.
  
  
  
  Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million.
  
  
  
  Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA. bidrisov@gmail.com.
authors.forename: Bulat
authors.identifier: 0000-0002-1971-2572
authors.initials: B
authors.lastname: Idrisov
authors.affiliation: Department of Health Policy and Administration, Washington State University, Spokane, WA, 99202, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.affiliation: Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA, 02454, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Morrill
authors.affiliation: Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA, 02454, USA.
authors.forename: Mayada
authors.initials: M
authors.lastname: Saadoun
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
authors.forename: Karsten
authors.initials: K
authors.lastname: Lunze
authors.affiliation: Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA, 02454, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Shepard
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D018803:Models, Economic; D058850:Opiate Substitution Treatment / Q000191:economics*; D009293:Opioid-Related Disorders / Q000188:drug therapy; D019057:Quality-Adjusted Life Years; D012426:Russia
chemical_list: D008691:Methadone
keywords: Drug dependence; HIV treatment; Methadone; Russia HIV; TB