Costs of Addressing Heroin Addiction inMalaysia and 32 Comparable Countries Worldwide

Abstract

Objective. Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Data Sources/Study Setting. Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients ( July 2003-May 2005 in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Study Design. Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Principal Findings. Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29-53 percent) and buprenorphine (33 -72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Conclusions. Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. Key Words. Malaysia, micro-costing, gross-costing, heroin treatment, international comparison, health systemsThere are an estimated 13-22 million opiate users globally, with more than half residing in Asia (United Nations Office on Drugs and Crime [UNODC] 2010). Heroin use in Malaysia has reached significant levels, with 234,000

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“…This study, along with others we have conducted [23], [24], [25], helped exemplify the execution of micro-costing analysis for health care interventions. This addresses a gap in the literature where in spite of the Panel’s recommendation of micro-costing, existing guidelines for economic evaluations do not provide sufficient specifics for the exact costing methods [16].…”

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