Estimation of life expectancy and the expected years of life lost among heroin users in the era of opioid substitution treatment (OST) in Taiwan

Chang, Kun Chia; Lu, Tsung Hsueh; Lee, Kuan Ying; Hwang, J. S.; Cheng, Ching Ming; Wang, Jung‐Der

doi:10.1016/j.drugalcdep.2015.05.033

Cited by 23 publications

(26 citation statements)

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“…The Taiwan OAT study (see Chang et al, 2015, for details) was a pilot methadone maintenance treatment (MMT) program started in 2006 by the Taiwan Center for Disease Control (CDC) in four of Taiwan’s 23 administrative regions (3 in northern Taiwan and one in the Jianan Psychiatric Center in the south). The Taiwan CDC also permitted buprenorphine-naloxone (Suboxone ®) to be used in a second pilot study, beginning, as well, in 2006.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical profiles at baseline for the 1,267 participants in the U.S. START study and the 983 cases in the Taiwan OAT study are provided in Table 1 and have been presented in previous articles (Chang et al, 2015; Hser et al, 2014; Hser et al, 2015). The mean age at baseline was 37.4 for the U.S. START participants and 37.8 for the Taiwan OAT participants.…”

Section: Methodsmentioning

confidence: 99%

“…The semi-parametric survival extrapolation method described above has been described in detail in other studies (Chang et al, 2015; Fang et al, 2007; Liu et al, 2013; Andersson et al, 2013). To facilitate the computation, we used an ISQoL (integration of survival and quality of life) software program, which can be freely downloaded from http://www.stat.sinica.edu.tw/jshwang (the present analysis examined only survival).…”

Section: Methodsmentioning

confidence: 99%

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Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

Chang

Wang

Saxon

et al. 2017

International Journal of Drug Policy

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Aims This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. Methods Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1,267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country. Results Compared with age- and gender- matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan. Conclusions Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

Chang

Wang

Saxon

et al. 2017

International Journal of Drug Policy

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“…YLL were calculated by multiplying the number of deaths in a year by the average number of years of life lost due to opioid use. For YLL, we used the all-cause mortality rates estimated by Chang et al [7], both for patients who used heroin and were in opioid substitution therapy, 15.5 per 1000 person years, and those who were not in opioid substitution therapy, 23.9 per 1000 person years. We then multiplied these figures by the respective average number of years of life lost, which were 10.6 for patients who used heroin and were on methadone therapy and 18.6 for those who were not [7].…”

Section: Methodsmentioning

confidence: 99%

“…For YLL, we used the all-cause mortality rates estimated by Chang et al [7], both for patients who used heroin and were in opioid substitution therapy, 15.5 per 1000 person years, and those who were not in opioid substitution therapy, 23.9 per 1000 person years. We then multiplied these figures by the respective average number of years of life lost, which were 10.6 for patients who used heroin and were on methadone therapy and 18.6 for those who were not [7]. To calculate YLD, we first estimated the prevalent number of individuals with an OUD and a comorbid HIV infection, and the number with an OUD and comorbid HIV and tuberculosis (TB) infections, as well as the number with an OUD who did not have these comorbidities.…”

Section: Methodsmentioning

confidence: 99%

Implementation of methadone therapy for opioid use disorder in Russia – a modeled cost-effectiveness analysis

Idrisov

Murphy

Morrill

et al. 2017

Subst Abuse Treat Prev Policy

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BackgroundOpioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD.Methods/DesignWe modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%.ResultsProviding methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million.ConclusionOur study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

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Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence

et al. 2021

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IMPORTANCE Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence; however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality.OBJECTIVE To estimate the association of time receiving OAT with mortality.DATA SOURCES The Embase, MEDLINE, and PsycINFO databases were searched through February 18, 2020, including clinical trial registries and previous Cochrane reviews.STUDY SELECTION All observational studies that collected data on all-cause or cause-specific mortality among people with opioid dependence while receiving and not receiving OAT were included. Randomized clinical trials (RCTs) were also included. DATA EXTRACTION AND SYNTHESISThis systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data on study, participant, and treatment characteristics were extracted; person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. MAIN OUTCOMES AND MEASURESOverall all-cause and cause-specific mortality both by setting and by participant characteristics. Methadone and buprenorphine OAT were evaluated specifically. RESULTSFifteen RCTs including 3852 participants and 36 primary cohort studies including 749 634 participants were analyzed. Among the cohort studies, the rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47; 95% CI, 0.42-0.53). This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection. Associations were not different for methadone (RR, 0.47; 95% CI, 0.41-0.54) vs buprenorphine (RR, 0.34; 95% CI, 0.26-0.45). There was lower risk of suicide (RR, 0.48; 95% CI, 0.37-0.61), cancer (RR, 0.72; 95% CI, 0.52-0.98), drug-related (RR, 0.41; 95% CI, 0.33-0.52), alcohol-related (RR, 0.59; 95% CI, 0.49-0.72), and cardiovascular-related (RR, 0.69; 95% CI, 0.60-0.79) mortality during OAT. In the first 4 weeks of methadone treatment, rates of all-cause mortality and drug-related poisoning were almost double the rates during the remainder of OAT (RR, 2.01; 95% CI, 1.55-5.09) but not for buprenorphine (RR, 0.58; 95% CI, 0.18-1.85). All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01; 95% CI,, remaining double the rate for the remainder of time not receiving OAT (RR, 1.81; 95% CI, 1.50-2.18). Opioid agonist treatment was associated with a lower risk of mortality during incarceration (RR, 0.06; 95% CI, 0.01-0.46) and after release from incarceration (RR, 0.09; 95% CI, 0.02-0.56). CONCLUSIONS AND RELEVANCEThis systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage of OAT remains ...

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Estimation of life expectancy and the expected years of life lost among heroin users in the era of opioid substitution treatment (OST) in Taiwan

Abstract: OST saves 7.8 EYLL more than non-OST after accounting for lead time bias. Effective suicide prevention programs could enhance its life-saving effect, especially among those co-morbid with depressive disorders.

Cited by 23 publications

References 36 publications

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

Implementation of methadone therapy for opioid use disorder in Russia – a modeled cost-effectiveness analysis

Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence

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