The cost-effectiveness of methadone maintenance as a health care intervention
The cost-effectiveness of methadone maintenance as a health care intervention
复制标题
DOI：
10.1046/j.1360-0443.1999.9444793.x
复制
发表时间：
1999-04-01
期刊：
影响因子：
6
通讯作者：
Barnett, PG
中科院分区：
文献类型：
--
作者：
Barnett, PG
目标。以生存年限作为治疗效益衡量指标的成本-效果分析被广泛应用于卫生保健干预措施的经济评价，但尚未被应用于药物滥用治疗。对美沙酮维持治疗的成本-效果进行了评价，以论证该方法在药物滥用治疗中应用的可行性。设计。通过文献回顾来确定美沙酮治疗对阿片成瘾相关死亡率的影响。还获得了关于平均治疗费用和持续时间的信息。使用二态马尔可夫模型估计美沙酮对一组25岁海洛因使用者的寿命和治疗费用的递增效应。调查结果。为鸦片成瘾者提供美沙酮维持服务，每增加一年的成本效益比就增加5915美元(也就是说，为鸦片成瘾者提供美沙酮每挽救一年生命，就会额外产生5915美元的治疗费用)。单向敏感性分析确定，在广泛的建模假设下，这一比率低于每生命年10,000美元。结论。美沙酮所厘定的比例，较很多常见医疗疗法的比例为低，亦远低於5万元的成本效益标准。即使决策者不希望使用适用于普通人群的相同比例，这种方法也可以将药物滥用治疗的改进与向药物滥用障碍患者提供的卫生服务的改善进行比较。未来的工作将需要有关美沙酮治疗对医疗保健和公共计划成本的影响、患者产生的间接成本以及反映生活质量的调整的信息。
Aims. Cost-effectiveness analysis using life-years of survival as the measure of treatment benefit is widely used in the economic evaluation of health care interventions but has not been applied to substance abuse treatment. The cost-effectiveness of methadone maintenance was evaluated to demonstrate the feasibility of applying this method to substance abuse treatment. Design. A literature review was undertaken to determine the effect of methadone treatment on the rate of mortality associated with opiate addiction. Information was also obtained on the average cost and duration of treatment. A two-state Markov model was used to estimate the incremental effect of methadone on the life span and treatment cost of a cohort of 25-year-old heroin users. Findings. Providing opiate addicts with access to methadone maintenance has an incremental cost-effectiveness ratio of $5915 per life-year gained (that is, for every year of life that is saved by providing methadone to opiate addicts, an additional $5915 in treatment costs are incurred). One-way sensitivity analysis determined that the ratio was less than $10 000 per-life year over a wide range of modeling assumptions. Conclusions. The ratio determined for methadone is lower than that of many common medical therapies, and well within the $50 000 threshold for judging cost-effectiveness. Even if decision makers do not wish use the same ratio that is applied to the general population, this method allows substance abuse treatment enhancements to be compared to improvements in health services offered to individuals with substance abuse disorders. Future work will require information on the impact of methadone treatment on the cost of health care and public programs, the indirect costs incurred by patients, and adjustments to reflect quality of life.