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Economic Evaluation of Interventions to Treat Opiate Dependence

A Review of the Evidence

PharmacoEconomics volume 26, pages 371–393 (2008)Cite this article

Abstract

Opiate dependence imposes a significant economic burden on society in terms of treatment-related costs and prevention services, other healthcare costs, the work absenteeism of patients, productivity loss arising from premature death of patients, costs associated with crime, and social welfare expenditure.

The objective of this research is to review the literature on economic evaluation of treatment of opiate dependence (including detoxification, maintenance and psychosocial support).

A literature review was performed on several electronic databases, including MEDLINE (Ovid), Cochrane Database of Systematic Reviews, NHS Economic Evaluation Library Database (via Cochrane Library), Web of Science, Social Science Citations Index, EMBASE and PsycINFO. A sensitive approach was used in order to maximize the number of articles retrieved; no language or publication year limitations were applied to the searches. A combination of subject heading term searches and natural word searches were used. The Drummond checklist was applied to assess the quality of economic evaluations.

A total of 259 articles were considered relevant, with eight review studies identified. The treatment spectrum ranged from detoxification to maintenance treatments involving the use of agonist and/or antagonist treatments. The evidence suggests that, although the quality of economic evaluations is reasonably good, there is a dearth of knowledge about the cost effectiveness of treatments for opiate dependence. The majority of the literature reporting the results of cost-effectiveness analyses used surrogate outcome measures and adopted a narrow treatment provider perspective. Studies that have conducted cost-benefit analyses, in spite of methodological divergences, generally adopted a societal perspective and consistently demonstrated positive economic returns from opiate treatment. A paucity of research examined the extent to which psychosocial or behavioural interventions support or replace conventional pharmacological approaches.

Economic evaluation provides a useful framework to assist policy makers in allocating resources across competing needs. Opiate dependence is a considerable burden on society’s resources, and treatment provides a cost-beneficial solution to address these consequences. However, to better inform the decision-making process, researchers must continue to produce high-quality, methodological, comparable and scientifically credible economic evaluations.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review other than normal salary paid by the University of Queensland. The author has no conflicts of interest that are directly relevant to the content of this review. The views expressed in this paper are those of the author only and as such the author accepts full responsibility for any errors or inaccuracies that may remain. Adrian Carter provided research assistance. The author is grateful for comments made by two anonymous reviewers and the editor.

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    Christopher M. Doran

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Doran, C.M. Economic Evaluation of Interventions to Treat Opiate Dependence. Pharmacoeconomics 26, 371–393 (2008). https://doi.org/10.2165/00019053-200826050-00003

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Keywords

  • Economic Evaluation
  • Heroin
  • Buprenorphine
  • Naltrexone
  • Methadone Maintenance Treatment