Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

doi:10.1136/bmj.330.7503.1297

BMJ 2005;330:1297 (4 June), doi:10.1136/bmj.330.7503.1297

Paper

Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

Marcel G W Dijkgraaf, senior researcher¹, Bart P van der Zanden, researcher¹, Corianne A J M de Borgie, senior researcher¹, Peter Blanken, researcher², Jan M van Ree, professor³, Wim van den Brink, professor⁴

¹ Department of Clinical Epidemiology and Biostatistics (J1B-216) Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands, ² Central Committee on the Treatment of Heroin Addicts (CCBH), Stratenum, Universiteitsweg 100, 3584 CG Utrecht, Netherlands, ³ Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Stratenum, Universiteitsweg 100, 3584 CG Utrecht, Netherlands, ⁴ Department of Psychiatry Academic Medical Centre, University of Amsterdam, Amsterdam

Correspondence to: M G W Dijkgraaf m.g.dijkgraaf{at}amc.uva.nl

Objective To determine the cost utility of medical co-prescriptionof heroin compared with methadone maintenance treatment forchronic, treatment resistant heroin addicts.

Design Cost utility analysis of two pooled open label randomisedcontrolled trials.

Setting Methadone maintenance programmes in six cities in theNetherlands.

Participants 430 heroin addicts.

Interventions Inhalable or injectable heroin prescribed over12 months. Methadone (maximum 150 mg a day) plus heroin (maximum1000 mg a day) compared with methadone alone (maximum 150 mga day). Psychosocial treatment was offered throughout.

Main outcome measures One year costs estimated from a societalperspective. Quality adjusted life years (QALYs) based on responsesto the EuroQol EQ-5D at baseline and during the treatment period.

Results Co-prescription of heroin was associated with 0.058more QALYs per patient per year (95% confidence interval 0.016to 0.099) and a mean saving of ${euro}$ 12 793 (£8793, $16 122)( ${euro}$ 1083 to ${euro}$ 25 229) per patient per year. The higher programmecosts ( ${euro}$ 16 222; lower 95% confidence limit ${euro}$ 15 084) were compensatedfor by lower costs of law enforcement (- ${euro}$ 4129; upper 95% confidencelimit - ${euro}$ 486) and damage to victims of crime (- ${euro}$ 25 374; upper95% confidence limit - ${euro}$ 16 625). The results were robust forthe use of national EQ-5D tariffs and for the exclusion of theinitial implementation costs of heroin treatment. Completionof treatment is essential; having participated in any abstinencetreatment in the past is not.

Conclusions Co-prescription of heroin is cost effective comparedwith treatment with methadone alone for chronic, treatment resistantheroin addicts.

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