Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification

FRANÇAIS :
Létude a été menée de mai 1995 à avril 1999, auprès de 179 usagers dépendants des opiacés. Les patients ont été assignés pendant les premiers 6 mois soit à un traitement standard (91 patients) soit à une désintoxication comportant 3 heures par semaine de thérapie psychosociale plus 14 sessions déducation au cours des 6 mois (88 patients). Pour un rapport coût-efficacité, situé dans une moyenne acceptable pour une intervention médicale, le traitement de maintenance à la méthadone est supérieur à la désintoxication renforcée et présente un avantage en terme de survie.
ENGLISH :
Aims: To compare the cost and cost-effectiveness of methadone maintenance treatment and 180-day methadone detoxification enriched with psychosocial services. Design: Randomized controlled study conducted from May 1995 to April 1999. Setting: Research clinic in an established drug treatment program. Participants: One hundred and seventy-nine adults with diagnosed opioid dependence. Intervention: Patients were randomized to methadone maintenance (n = 91), which required monthly 1 hour/week of psychosocial therapy during the first 6 months or 180-day detoxification (n= 88), which required 3 hours/week of psychosocial therapy and 14 education sessions during the first 6 months. Measurements: Total health-care costs and self reported injection drug use. A two-state Markov model was used to estimate quality-adjusted years of survival. Findings: Methadone maintenance produced significantly greater reductions in illicit opioid use than 180-day detoxification during the last 6 months of treatment. Total health-care costs were greater for maintenance than detoxification treatment ($ 7564 versus $ 6687 ; P < 0.001). Although study costs were significantly higher for methadone maintenance than detoxification patients ($4739 versus $2855, P < 0.001), detoxification patients incurred significantly higher costs for substance abuse and mental health care received outside the study. Methadone maintenance may provide a modest survival advantage compared with detoxification. The cost per life-year gained is $16 967. Sensitivity analysis revealed a cost-effectiveness ratio of less than $20 000 per quality-adjusted life-year over a wide range of modeling assumptions. Conclusions: Compared with enriched detoxification services, methadone maintenance is more effective than enriched detoxification services with a cost-effectiveness ratio within the range of many accepted medical interventions and may provide a survival advantage. Results provide additional support for the use of sustained methadone therapy as opposed to detoxification for treating opioid addiction. (Author' s abstract)