Re-engineering methadone-Cost-effectiveness analysis of a patient-centered approach to methadone treatment.

Journal of Substance Abuse Treatment
Laura J DunlapRobert P Schwartz

Abstract

Methadone maintenance treatment has proven effectiveness in the treatment of opioid use disorder, but significant barriers remain to treatment retention. In a randomized clinical trial, 300 newly-admitted methadone patients were randomly assigned to patient-centered methadone (PCM) v. treatment-as-usual (TAU). In PCM, participants were treated under revised program rules which permitted voluntary attendance at counseling and other changes focused on reducing involuntary discharge, and different staff roles which shifted disciplinary responsibility from the participant's counselor to the supervisor. The study found no significant differences in treatment retention, measures of opioid use, or other patient outcomes. This paper employs an activity-based costing approach to estimate the cost and cost-effectiveness of the two study conditions. We found that service use and costs were similar between PCM and TAU. Specifically, the average cost for PCM patients was $2396 compared to $2292 for standard methadone, while the average length of stay was 2 weeks longer for PCM patients. Incremental cost-effectiveness ratios (ICER) for self-reported heroin use, opioid positive urine screens, and meeting DSM-IV criteria for opioid dependence ...Continue Reading

Citations

Sep 30, 2020·Drug and Alcohol Dependence·Gary A ZarkinRobert P Schwartz
May 21, 2021·BMJ : British Medical Journal·Megan BureshDarius Rastegar
Jul 11, 2021·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Erica N OnuohaSean M Murphy

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