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HIV transmission and the cost-effectiveness of methadone maintenance

Author

Listed:
  • Zaric, G.S.
  • Barnett, P.G.
  • Brandeau, M.L.

Abstract

Objectives. This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. Methods. We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. Results. Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14100 and $15200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. Conclusions. Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.

Suggested Citation

  • Zaric, G.S. & Barnett, P.G. & Brandeau, M.L., 2000. "HIV transmission and the cost-effectiveness of methadone maintenance," American Journal of Public Health, American Public Health Association, vol. 90(7), pages 1100-1111.
    • Handle: RePEc:aph:ajpbhl:2000:90:7:1100-1111_9
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    Cited by:

    1. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    2. Afriandi, Irvan & Siregar, Adiatma Y.M. & Meheus, Filip & Hidayat, Teddy & van der Ven, Andre & van Crevel, Reinout & Baltussen, Rob, 2010. "Costs of hospital-based methadone maintenance treatment in HIV/AIDS control among injecting drug users in Indonesia," Health Policy, Elsevier, vol. 95(1), pages 69-73, April.
    3. Lauren E Cipriano & Gregory S Zaric & Mark Holodniy & Eran Bendavid & Douglas K Owens & Margaret L Brandeau, 2012. "Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-14, September.
    4. Margaret L. Brandeau, 2016. "Creating impact with operations research in health: making room for practice in academia," Health Care Management Science, Springer, vol. 19(4), pages 305-312, December.
    5. Xiao Zang & Houlin Tang & Jeong Eun Min & Diane Gu & Julio S G Montaner & Zunyou Wu & Bohdan Nosyk, 2016. "Cost-Effectiveness of the ‘One4All’ HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-17, November.
    6. Gary A. Zarkin & Laura J. Dunlap & Katherine A. Hicks & Daniel Mamo, 2005. "Benefits and costs of methadone treatment: results from a lifetime simulation model," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1133-1150, November.
    7. Margaret Brandeau & Gregory Zaric, 2009. "Optimal investment in HIV prevention programs: more is not always better," Health Care Management Science, Springer, vol. 12(1), pages 27-37, March.
    8. Iluminada Fuertes-Fuertes & J. David Cabedo & Inmaculada Jimeno-García, 2019. "Capturing the Invisible Wealth in Nonprofits to Overcome Myopic Perceptions," Sustainability, MDPI, vol. 12(1), pages 1-18, December.
    9. Gregory S. Zaric & Margaret L. Brandeau & Paul G. Barnett, 2000. "Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis," Management Science, INFORMS, vol. 46(8), pages 1013-1031, August.
    10. Lauren E. Cipriano & Shan Liu & Kaspar S. Shahzada & Mark Holodniy & Jeremy D. Goldhaber-Fiebert, 2018. "Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes," Medical Decision Making, , vol. 38(7), pages 849-865, October.
    11. Mark Roberts & Louise B. Russell & A. David Paltiel & Michael Chambers & Phil McEwan & Murray Krahn, 2012. "Conceptualizing a Model," Medical Decision Making, , vol. 32(5), pages 678-689, September.
    12. Wilson, Amy R. & Kahn, James G., 2003. "Preventing HIV in injection drug users: exploring the tradeoffs between interventions," Socio-Economic Planning Sciences, Elsevier, vol. 37(4), pages 269-288, December.
    13. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    14. Ruixuan Liu & Zhengfei Yu, 2019. "Accelerated Failure Time Models with Log-concave Errors," Tsukuba Economics Working Papers 2019-003, Faculty of Humanities and Social Sciences, University of Tsukuba.
    15. Zoë K. Harris, 2006. "Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 147-158, February.
    16. Sabina S Alistar & Douglas K Owens & Margaret L Brandeau, 2014. "Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    17. Emanuel Krebs & Jeong E. Min & Elizabeth Evans & Libo Li & Lei Liu & David Huang & Darren Urada & Thomas Kerr & Yih-Ing Hser & Bohdan Nosyk, 2017. "Estimating State Transitions for Opioid Use Disorders," Medical Decision Making, , vol. 37(5), pages 483-497, July.
    18. Benjamin Armbruster & Ekkehard Beck & Mustafa Waheed, 2014. "The importance of extended high viremics in models of HIV spread in South Africa," Health Care Management Science, Springer, vol. 17(2), pages 182-193, June.
    19. Margaret L. Brandeau, 2023. "Responding to the US opioid crisis: leveraging analytics to support decision making," Health Care Management Science, Springer, vol. 26(4), pages 599-603, December.
    20. Elisa F. Long & Naveen K. Vaidya & Margaret L. Brandeau, 2008. "Controlling Co-Epidemics: Analysis of HIV and Tuberculosis Infection Dynamics," Operations Research, INFORMS, vol. 56(6), pages 1366-1381, December.

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