Titre : | Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials |
Auteurs : | M. G. W. DIJKGRAAF ; B. P. VAN DER ZANDEN ; DE BORGIE C. A. J. M. ; P. BLANKEN ; J. M. VAN REE ; W. VAN DEN BRINK |
Type de document : | Périodique |
Année de publication : | 2005 |
Format : | 1297-1302 |
Note générale : | British Medical Journal, 2005, 330, (7503), 1297-1302 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés HEROINE ; METHADONE ; TRAITEMENT DE MAINTENANCE ; SUBSTITUTION ; PRESCRIPTION MEDICALE ; COUT ; QUALITE DE VIEThésaurus géographique PAYS-BAS |
Résumé : | Objective: To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. Design: Cost utility analysis of two pooled open label randomised controlled trials. Setting: Methadone maintenance programmes in six cities in the Netherlands. Participants: 430 heroin addicts. Interventions: Inhalable or injectable heroin prescribed over 12 months. Methadone (maximum 150 mg a day) plus heroin (maximum 1000 mg a day) compared with methadone alone (maximum 150 mg a day). Psychosocial treatment was offered throughout. Main outcome measures: One year costs estimated from a societal perspective. Quality adjusted life years (QALYs) based on responses to the EuroQol EQ-5D at baseline and during the treatment period. Results: Co-prescription of heroin was associated with 0.058 more QALYs per patient per year (95% confidence interval 0.016 to 0.099) and a mean saving of 12 793 (£8793, $16 122) (1083 to 25 229) per patient per year. The higher programme costs (16 222; lower 95% confidence limit 15 084) were compensated for by lower costs of law enforcement (- 4129; upper 95% confidence limit - 486) and damage to victims of crime (- 25 374; upper 95% confidence limit - 16 625). The results were robust for the use of national EQ-5D tariffs and for the exclusion of the initial implementation costs of heroin treatment. Completion of treatment is essential; having participated in any abstinence treatment in the past is not. Conclusions: Co-prescription of heroin is cost effective compared with treatment with methadone alone for chronic, treatment resistant heroin addicts. (Author' s abstract) |
Domaine : | Drogues illicites / Illicit drugs |
Affiliation : | Department of Clinical Epidemiology and Biostatistics (J1B-216) Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands |
Centre Emetteur : | 13 OFDT |
Cote : | A02159 |
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