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

Abstract

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.

Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia

“…There are also barriers to adequate addiction care for example opioid agonist therapy does not exist in Russia, and alcohol treatment guidelines are far from evidence-based. It is therefore challenging for providers to offer high-quality addiction treatment, which has been shown to improve HIV outcomes [ 11 , 15 , 24 ].…”

“…Achieving optimal HIV care cascade outcomes is particularly challenging in Eastern Europe. As healthcare services in Russia are organized by specialty [ 14 ], linking patients from addiction hospitals to HIV facilities can be a challenging transition [ 15 ]. This is mainly important since in the region, the overlapping prevalence of alcohol use, injection opioid use, and HIV infection is very high [ 16 , 17 ].…”

“…In Russia, healthcare, including addiction and ART, is provided free of charge at governmental facilities, such as addiction (i.e., narcology) or HIV clinics [ 15 ]. Opioid agonist therapy with methadone or buprenorphine is not available in Russia [ 22 ].…”

“…The standard of care at Russian inpatient addiction hospitals consists of diagnostic procedures, detoxification for 10–14 days and rehabilitation for an additional 30 days for selected patients. In the first week of hospitalization, patients are detoxified with possible use of tramadol, non-opiate analgesics, clonidine and benzodiazepines [ 15 , 24 ]. Patients receive drug counselling and treatment for comorbid psychiatric conditions within addiction hospitals, but integration to other treatment modalities such as HIV care is very limited.…”

National Institute on Drug Abuse International Program

“…Key research on the development and US approval of naltrexone in a long-lasting depot formulation (Vivitrol) was conducted in Russia, for example, which does not allow agonist treatment for OUD, despite recent projections that implementation of agonist OST would be highly cost-effective there [11]. …”