HIV transmission and the cost-effectiveness of methadone maintenance

Zaric, Gregory S.; Barnett, Paul G.; Brandeau, Margaret L.

doi:10.2105/ajph.90.7.1100

Cited by 197 publications

(54 citation statements)

References 153 publications

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“…When the problem requires modeling the effect of an intervention on disease spread, methods designed for patient interaction should be selected, such as dynamic transmission models [48,49], DES [50,51], and agent-based models [52]. Similarly, these methods are appropriate when individuals interact with other components of the model, such as use limited resources [53,54]. …”

Section: Conceptualizing the Modelmentioning

confidence: 99%

Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2

et al. 2012

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The appropriate development of a model begins with understanding the problem that is being represented. The aim of this article was to provide a series of consensus-based best practices regarding the process of model conceptualization. For the purpose of this series of articles, we consider the development of models whose purpose is to inform medical decisions and health-related resource allocation questions. We specifically divide the conceptualization process into two distinct components: the conceptualization of the problem, which converts knowledge of the health care process or decision into a representation of the problem, followed by the conceptualization of the model itself, which matches the attributes and characteristics of a particular modeling type with the needs of the problem being represented. Recommendations are made regarding the structure of the modeling team, agreement on the statement of the problem, the structure, perspective, and target population of the model, and the interventions and outcomes represented. Best practices relating to the specific characteristics of model structure and which characteristics of the problem might be most easily represented in a specific modeling method are presented. Each section contains a number of recommendations that were iterated among the authors, as well as among the wider modeling taskforce, jointly set up by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making.

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Section: Conceptualizing the Modelmentioning

confidence: 99%

Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2

et al. 2012

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“…This goal has not been reached in the United States or Canada, despite the demonstrated economic value of that treatment [18-21]. …”

Section: Financial Barriers To Treatmentmentioning

confidence: 99%

“…[18-21] Often the costs of treatment are more than offset by reductions in acquisitive crime (theft or burglary)[20] and in the use of health resources related to transmissions of HIV or hepatitis C.[21] The treatment also results in improvements in health-related quality of life. [22] substitution treatment may be even greater if potential increases in workplace productivity are realized[19], resulting in additional economic benefits outside of the health care sector.…”

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confidence: 99%

A Call For Evidence-Based Medical Treatment Of Opioid Dependence In The United States And Canada

et al. 2013

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Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine— two forms of opioid substitution therapy—gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Less than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the consequent harms of opioid dependence by maximizing the individual and public health benefits of treatment.

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“…While a continuation of the trend towards greater utilization of MMT may result in increased costs to the healthcare system, sustained retention in treatment has been shown to reduce the costs of acquisitive crime and may avert potential health care costs attributable to infectious diseases like HIV and Hepatitis C (Alter and Liang, 2012; US Food and Drug Administration, 2002). As a result, prior studies have shown MMT to be highly cost-effective, if not cost-saving (Nosyk et al, 2012; Zaric et al, 2000; Rosenblum et al, 2003). Further research is required to quantify the cumulative effects of repeated detoxification, compared to the current standard of care (MMT) in terms of morbidity, mortality, and incremental costs to society.…”

Section: Discussionmentioning

confidence: 99%

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991–2012

Nosyk¹,

Li²,

Evans³

et al. 2014

Drug and Alcohol Dependence

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Background California treats the largest population of opioid dependent individuals in the US and is among a small group of states that applies regulations for opioid treatment that are more stringent than existing federal regulations. We aim to characterize changes in patient characteristics and treatment utilization over time, and identify determinants of successful completion of detoxification and MMT retention in repeated attempts. Methods State-wide administrative data was obtained from California Outcome Measurement System during the period: January 1st, 1991 to March 31st, 2012. Short-term detoxification treatment and long-term maintenance treatment, primarily with methadone, was available to study participants. Mixed effects regression models were used to define determinants of successful completion of the detoxification treatment protocol (as classified by treatment staff) and duration of maintenance treatment. Results The study sample consisted of 237,709 unique individuals and 885,971 treatment episodes; 83.7% were detoxification treatment episodes in 1994, dropping to 40.5% in 2010. Among individuals accessing only detoxification, the adjusted odds of success declined with each successive attempt (vs. 1st attempt: 2nd: OR: 0.679; 95% CI (0.610, 0.755); 3rd: 0.557 (0.484, 0.641); 4th: 0.526 (0.445, 0.622); 5th: 0.407 (0.334, 0.497); ≥6th: 0.339 (0.288, 0.399). For those ever accessing maintenance treatment, later subsequent attempts were longer in duration, and those with two or more prior attempts at detoxification had marginally longer subsequent maintenance episodes (hazard ratio: 0.97; 95% CI: 0.95, 0.99). Finally, only 10.9% of all detoxification episodes were followed by admission into maintenance treatment within 14 days. Conclusions This study has revealed high rates of detoxification treatment for opioid dependence in California throughout the study period, and decreasing odds of success in repeated attempts at detoxification.

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HIV transmission and the cost-effectiveness of methadone maintenance

Cited by 197 publications

References 153 publications

Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2

Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2

A Call For Evidence-Based Medical Treatment Of Opioid Dependence In The United States And Canada

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991–2012

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