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Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis

Author

Listed:
  • Gregory S. Zaric

    (Ivey School of Business, University of Western Ontario, London, Ontario, N6A 3K7 Canada)

  • Margaret L. Brandeau

    (Department of Management Science and Engineering, Stanford University, Stanford, California 94305)

  • Paul G. Barnett

    (Center for Health Care Evaluation, Palo Alto Veterans Affairs Health Care System, Menlo Park, California 94205, and Department of Health Research and Policy, Stanford University, Stanford, California 94205)

Abstract

We assess the cost-effectiveness of maintenance treatment for heroin addiction, with emphasis on its role in preventing HIV infection. The analysis is based on a dynamic compartmental model of the HIV epidemic among a population of adults, ages 18 to 44. The population is divided into nine compartments according to infection status and risk group. The model takes into account disease transmission from drug injection and sexual contacts. The health benefits of methadone maintenance and the resulting HIV infections averted are measured in terms of life years gained and quality-adjusted life years gained. Costs considered include all health-care costs (including cost of HIV care and other health care) and the cost of methadone maintenance. The analysis shows that expanding existing methadone maintenance programs is a cost-effective health-care intervention that can play an important role in slowing the spread of HIV and improving the length and quality of life for injection drug users (IDUs), and that such expansion is cost-effective even in populations with low HIV prevalence among IDUs. Incremental expansion of methadone maintenance programs was found to have a cost-effectiveness ratio of between $9,700 and $17,200 per life year gained, and between $6,300 and $10,900 per quality-adjusted life year gained. Although methadone maintenance treatment is provided to IDUs, the analysis shows that significant benefits accrue to non-IDU members of the population. Sensitivity analysis shows that new methadone maintenance treatment slots will be cost-effective even if they are twice as expensive and half as effective in reducing risky behavior as current methadone maintenance programs.

Suggested Citation

  • 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.
    • Handle: RePEc:inm:ormnsc:v:46:y:2000:i:8:p:1013-1031
    DOI: 10.1287/mnsc.46.8.1013.12025
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    References listed on IDEAS

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    1. 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.
    2. Maidlow, S.T. & Berman, H., 1972. "The economics of heroin treatment," American Journal of Public Health, American Public Health Association, vol. 62(10), pages 1397-1406.
    3. Margaret L. Brandeau & Douglas K. Owens & Carol H. Sox & Robert M. Wachter, 1993. "Screening Women of Childbearing Age for Human Immunodeficiency Virus: A Model-Based Policy Analysis," Management Science, INFORMS, vol. 39(1), pages 72-92, January.
    4. Siegel, J.E. & Weinstein, M.C. & Fineberg, H.V., 1991. "Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence," American Journal of Public Health, American Public Health Association, vol. 81(10), pages 1273-1279.
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    Cited by:

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    2. Arielle Lasry & Stephanie Sansom & Katherine Hicks & Vladislav Uzunangelov, 2011. "A model for allocating CDC’s HIV prevention resources in the United States," Health Care Management Science, Springer, vol. 14(1), pages 115-124, March.
    3. Evrim Güneş, 2009. "Modeling time allocation for prevention in primary care," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 17(3), pages 359-380, September.
    4. Xuecheng Yin & İ. E. Büyüktahtakın, 2021. "A multi-stage stochastic programming approach to epidemic resource allocation with equity considerations," Health Care Management Science, Springer, vol. 24(3), pages 597-622, September.
    5. 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.
    6. James S. Dyer & James E. Smith, 2021. "Innovations in the Science and Practice of Decision Analysis: The Role of Management Science," Management Science, INFORMS, vol. 67(9), pages 5364-5378, September.
    7. Guihua Wang & Jun Li & Wallace J. Hopp & Franco L. Fazzalari & Steven F. Bolling, 2019. "Using Patient-Specific Quality Information to Unlock Hidden Healthcare Capabilities," Manufacturing & Service Operations Management, INFORMS, vol. 21(3), pages 582-601, July.
    8. Büyüktahtakın, İ. Esra & des-Bordes, Emmanuel & Kıbış, Eyyüb Y., 2018. "A new epidemics–logistics model: Insights into controlling the Ebola virus disease in West Africa," European Journal of Operational Research, Elsevier, vol. 265(3), pages 1046-1063.
    9. 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.
    10. Sarang Deo & Kumar Rajaram & Sandeep Rath & Uday S. Karmarkar & Matthew B. Goetz, 2015. "Planning for HIV Screening, Testing, and Care at the Veterans Health Administration," Operations Research, INFORMS, vol. 63(2), pages 287-304, April.
    11. Anirban Basu & A. David Paltiel & Harold A. Pollack, 2008. "Social costs of robbery and the cost‐effectiveness of substance abuse treatment," Health Economics, John Wiley & Sons, Ltd., vol. 17(8), pages 927-946, August.
    12. 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.
    13. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.

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