BY MARK SHWARTZ
Methadone maintenance treatment for injection drug users is a highly cost-effective way to combat the spread of HIV, according to a study just released by researchers from the Department of Veterans Affairs and Stanford University.
"If health care plans evaluated methadone like any another pharmaceutical, they would include it as a benefit because it is so very cost-effective," said lead author Greg Zaric, a former Stanford graduate student, "But many health plans do not provide this coverage."
More than one million people inject drugs in the U.S., but there is room for only 115,000 people in methadone treatment programs. Eight states have laws that prohibit methadone treatment of addiction.
In an article appearing in the July issue of the American Journal of Public Health, the researchers found that expansion in the capacity of U.S. methadone maintenance programs would result in significant health benefits to those in treatment as well as to the general population. Treatment expansion would reduce the spread of HIV to the general population. This effect is so significant that most of its health benefit of treatment expansion would be realized by people who are not in methadone maintenance and do not inject drugs.
The authors report that barriers to methadone, including excessive regulation and its exclusion from private and public health plans, are denying addicted individuals a cost-effective therapy.
The findings emerged from a dynamic model of the HIV epidemic based on extensive review of literature on methadone effectiveness, HIV transmission and health care costs. The model was used to simulate how methadone expansion would affect total health care costs, the spread of HIV, and the number of quality-adjusted years of life experienced by treated and untreated heroin users, the people they contact, and the rest of the population.
Expansion of methadone programs would be highly cost-effective in communities like New York, where 40 percent of injection drug users are HIV infected. Treatment expansion would be only slightly less cost-effective in communities like Los Angeles, where only 5 percent of injection drug users are HIV infected. The study estimated that expansion of methadone treatment capacity would cost between $8,200 and $10,900 for every quality-adjusted life year gained. This cost-effectiveness ratio is substantially lower than that of many widely used medical care interventions, and well below the frequently used threshold of judging health care interventions, which is $50,000 per quality-adjusted life year gained.
The authors conclude that, even though methadone maintenance does not lead to a complete or permanent cessation of drug use, it is a cost-effective way of slowing the spread of HIV.
This research was conducted by a team from the V.A. Palo Alto Health Care System and Stanford University, with support from the National Institute on Drug Abuse.
The report was authored by Zaric, Paul G. Barnett and Margaret L. Brandeau. Zaric was employed by the Veterans Administration while a graduate student at Stanford. He is now assistant professor at the Ivey School of Business at the University of Western Ontario. Barnett is Health Economist in the V.A. Cooperative Studies Program and Director of the V.A. Health Economics Resource Center in Menlo Park, California. SR