Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trialsBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7503.1297 (Published 02 June 2005) Cite this as: BMJ 2005;330:1297
- Marcel G W Dijkgraaf, senior researcher ()1,
- 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
- Accepted 13 April 2005
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.
Contributors MGWD, CAJMdB, WvdB, and JMvR were responsible for concept and design. MGWD, BPvdZ, and PB were responsible for analysis. MGWD and BPvdZ wrote the first draft of the paper. All authors interpreted the data, revised the manuscript, and approved the paper. MGWD is guarantor.
Funding The study was commissioned and financially supported by the Netherlands Ministry of Health, Welfare, and Sports.
Competing interests None declared.
Ethical approval The study was approved by the central committee on medical ethics (KEMO) and the substudy by the central committee on research involving human subjects (CCMO). All participants provided written informed consent.
- Accepted 13 April 2005