A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence
A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence
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DOI：
10.1111/add.13073
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发表时间：
2015-12-01
期刊：
影响因子：
6
通讯作者：
Degenhardt, Louisa
中科院分区：
文献类型：
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作者：
Gisev, Natasa;Shanahan, Marian;Degenhardt, Louisa
目的虽然阿片类药物替代疗法(OST)在出狱后立即使用可降低死亡率，但治疗的成本-效果尚未得到检验。因此，我们在释放后的前6个月进行了OST治疗和预防死亡的成本-效果分析。设计基于人口的回溯性数据关联研究，使用了OST入侵者的记录(1985年至2010年)、指控和出庭(1993年至2011年)、监狱事件(2000年至2011年)和死亡通知(1985年至2011年)。研究背景设在澳大利亚新南威尔士州。参与者16073名有阿片依赖史的人在2000年1月1日至2011年6月30日首次从监狱释放。干预性OST治疗与在监狱没有OST治疗的比较。测量死亡率和成本(治疗、刑事司法系统、处罚、成本)在释放后6个月评估监狱和犯罪的社会成本。分析包括倾向得分匹配、自举和回归。结果共匹配13468人(每组6734人)。在OST上释放的20人(0.3%)死亡，而没有在OST上释放的46人(0.7%)死亡。接受OST后发布的组的最终平均成本较低(7,206美元对14356美元)。增量成本-效果比表明，OST后释放占主导地位，产生较低的成本和挽救更多的生命。在愿意支付500美元的情况下，OST释放后每挽救一年生命年具有成本效益的概率为96.7%。结论对有阿片依赖史的人在出狱时给予阿片类药物替代治疗(与不使用阿片类药物治疗相比)，在降低释放前6个月的死亡率方面具有成本效益。
AimAlthough opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6months post-release.DesignPopulation-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011).SettingNew South Wales, Australia.ParticipantsA cohort of 16073 people with a history of opioid dependence released from prison for the first time between 1January 2000 and 30June 2011.InterventionOST treatment compared to no OST treatment at prison release.MeasurementsMortality and costs (treatment, criminal justice systemcourt, penalties, prisonand the social costs of crime) were evaluated at 6months post-release. Analyses included propensity score matching, bootstrapping and regression.FindingsA total of 13468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.ConclusionOpioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6months of release.