IDEAS home Printed from https://ideas.repec.org/a/inm/ormnsc/v46y2000i8p1013-1031.html
   My bibliography  Save this article

Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis

Author

Listed:
  • Gregory S. Zaric

    (Ivey School of Business, University of Western Ontario, London, Ontario, N6A 3K7 Canada)

  • Margaret L. Brandeau

    (Department of Management Science and Engineering, Stanford University, Stanford, California 94305)

  • Paul G. Barnett

    (Center for Health Care Evaluation, Palo Alto Veterans Affairs Health Care System, Menlo Park, California 94205, and Department of Health Research and Policy, Stanford University, Stanford, California 94205)

Abstract

We assess the cost-effectiveness of maintenance treatment for heroin addiction, with emphasis on its role in preventing HIV infection. The analysis is based on a dynamic compartmental model of the HIV epidemic among a population of adults, ages 18 to 44. The population is divided into nine compartments according to infection status and risk group. The model takes into account disease transmission from drug injection and sexual contacts. The health benefits of methadone maintenance and the resulting HIV infections averted are measured in terms of life years gained and quality-adjusted life years gained. Costs considered include all health-care costs (including cost of HIV care and other health care) and the cost of methadone maintenance. The analysis shows that expanding existing methadone maintenance programs is a cost-effective health-care intervention that can play an important role in slowing the spread of HIV and improving the length and quality of life for injection drug users (IDUs), and that such expansion is cost-effective even in populations with low HIV prevalence among IDUs. Incremental expansion of methadone maintenance programs was found to have a cost-effectiveness ratio of between $9,700 and $17,200 per life year gained, and between $6,300 and $10,900 per quality-adjusted life year gained. Although methadone maintenance treatment is provided to IDUs, the analysis shows that significant benefits accrue to non-IDU members of the population. Sensitivity analysis shows that new methadone maintenance treatment slots will be cost-effective even if they are twice as expensive and half as effective in reducing risky behavior as current methadone maintenance programs.

Suggested Citation

  • Gregory S. Zaric & Margaret L. Brandeau & Paul G. Barnett, 2000. "Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis," Management Science, INFORMS, vol. 46(8), pages 1013-1031, August.
    • Handle: RePEc:inm:ormnsc:v:46:y:2000:i:8:p:1013-1031
    DOI: 10.1287/mnsc.46.8.1013.12025
    as

    Download full text from publisher

    File URL: http://dx.doi.org/10.1287/mnsc.46.8.1013.12025
    Download Restriction: no
    File URL: https://libkey.io/10.1287/mnsc.46.8.1013.12025?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Maidlow, S.T. & Berman, H., 1972. "The economics of heroin treatment," American Journal of Public Health, American Public Health Association, vol. 62(10), pages 1397-1406.
    2. Margaret L. Brandeau & Douglas K. Owens & Carol H. Sox & Robert M. Wachter, 1993. "Screening Women of Childbearing Age for Human Immunodeficiency Virus: A Model-Based Policy Analysis," Management Science, INFORMS, vol. 39(1), pages 72-92, January.
    3. Siegel, J.E. & Weinstein, M.C. & Fineberg, H.V., 1991. "Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence," American Journal of Public Health, American Public Health Association, vol. 81(10), pages 1273-1279.
    4. Zaric, G.S. & Barnett, P.G. & Brandeau, M.L., 2000. "HIV transmission and the cost-effectiveness of methadone maintenance," American Journal of Public Health, American Public Health Association, vol. 90(7), pages 1100-1111.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Evrim Güneş, 2009. "Modeling time allocation for prevention in primary care," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 17(3), pages 359-380, September.
    2. Xuecheng Yin & İ. E. Büyüktahtakın, 2021. "A multi-stage stochastic programming approach to epidemic resource allocation with equity considerations," Health Care Management Science, Springer, vol. 24(3), pages 597-622, September.
    3. James S. Dyer & James E. Smith, 2021. "Innovations in the Science and Practice of Decision Analysis: The Role of Management Science," Management Science, INFORMS, vol. 67(9), pages 5364-5378, September.
    4. Sarang Deo & Kumar Rajaram & Sandeep Rath & Uday S. Karmarkar & Matthew B. Goetz, 2015. "Planning for HIV Screening, Testing, and Care at the Veterans Health Administration," Operations Research, INFORMS, vol. 63(2), pages 287-304, April.
    5. Margaret L. Brandeau, 2016. "Creating impact with operations research in health: making room for practice in academia," Health Care Management Science, Springer, vol. 19(4), pages 305-312, December.
    6. Arielle Lasry & Stephanie Sansom & Katherine Hicks & Vladislav Uzunangelov, 2011. "A model for allocating CDC’s HIV prevention resources in the United States," Health Care Management Science, Springer, vol. 14(1), pages 115-124, March.
    7. Wilson, Amy R. & Kahn, James G., 2003. "Preventing HIV in injection drug users: exploring the tradeoffs between interventions," Socio-Economic Planning Sciences, Elsevier, vol. 37(4), pages 269-288, December.
    8. Guihua Wang & Jun Li & Wallace J. Hopp & Franco L. Fazzalari & Steven F. Bolling, 2019. "Using Patient-Specific Quality Information to Unlock Hidden Healthcare Capabilities," Manufacturing & Service Operations Management, INFORMS, vol. 21(3), pages 582-601, July.
    9. Büyüktahtakın, İ. Esra & des-Bordes, Emmanuel & Kıbış, Eyyüb Y., 2018. "A new epidemics–logistics model: Insights into controlling the Ebola virus disease in West Africa," European Journal of Operational Research, Elsevier, vol. 265(3), pages 1046-1063.
    10. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    11. Anirban Basu & A. David Paltiel & Harold A. Pollack, 2008. "Social costs of robbery and the cost‐effectiveness of substance abuse treatment," Health Economics, John Wiley & Sons, Ltd., vol. 17(8), pages 927-946, August.
    12. Sabina S Alistar & Douglas K Owens & Margaret L Brandeau, 2014. "Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    13. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Zoë K. Harris, 2006. "Efficient allocation of resources to prevent HIV infection among injection drug users: the Prevention Point Philadelphia (PPP) needle exchange program," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 147-158, February.
    2. James G. Kahn & Margaret L. Brandeau & John Dunn-Mortimer, 1998. "OR Modeling and AIDS Policy: From Theory to Practice," Interfaces, INFORMS, vol. 28(3), pages 3-22, June.
    3. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    4. Mark Roberts & Louise B. Russell & A. David Paltiel & Michael Chambers & Phil McEwan & Murray Krahn, 2012. "Conceptualizing a Model," Medical Decision Making, , vol. 32(5), pages 678-689, September.
    5. Sabina Alistar & Elisa Long & Margaret Brandeau & Eduard Beck, 2014. "HIV epidemic control—a model for optimal allocation of prevention and treatment resources," Health Care Management Science, Springer, vol. 17(2), pages 162-181, June.
    6. Emanuel Krebs & Jeong E. Min & Elizabeth Evans & Libo Li & Lei Liu & David Huang & Darren Urada & Thomas Kerr & Yih-Ing Hser & Bohdan Nosyk, 2017. "Estimating State Transitions for Opioid Use Disorders," Medical Decision Making, , vol. 37(5), pages 483-497, July.
    7. Gary A. Zarkin & Laura J. Dunlap & Katherine A. Hicks & Daniel Mamo, 2005. "Benefits and costs of methadone treatment: results from a lifetime simulation model," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1133-1150, November.
    8. Negar Darabi & Niyousha Hosseinichimeh, 2020. "System dynamics modeling in health and medicine: a systematic literature review," System Dynamics Review, System Dynamics Society, vol. 36(1), pages 29-73, January.
    9. Wilson, Amy R. & Kahn, James G., 2003. "Preventing HIV in injection drug users: exploring the tradeoffs between interventions," Socio-Economic Planning Sciences, Elsevier, vol. 37(4), pages 269-288, December.
    10. Douglas K. Owens & Margaret L. Brandeau & Carol H. Sox, 1998. "Effect of Relapse to High-Risk Behavior on the Costs and Benefits of a Program to Screen Women for Human Immunodeficiency Virus," Interfaces, INFORMS, vol. 28(3), pages 52-74, June.
    11. Afriandi, Irvan & Siregar, Adiatma Y.M. & Meheus, Filip & Hidayat, Teddy & van der Ven, Andre & van Crevel, Reinout & Baltussen, Rob, 2010. "Costs of hospital-based methadone maintenance treatment in HIV/AIDS control among injecting drug users in Indonesia," Health Policy, Elsevier, vol. 95(1), pages 69-73, April.
    12. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.
    13. Zheng Zhang & Brian T. Denton & Todd M. Morgan, 2022. "Optimization of active surveillance strategies for heterogeneous patients with prostate cancer," Production and Operations Management, Production and Operations Management Society, vol. 31(11), pages 4021-4037, November.
    14. Steven D. Pinkerton & Harrell W. Chesson & David R. Holtgrave & William Kassler & Peter M. Layde, 2000. "When is an HIV Infection Prevented and when is it Merely Delayed?," Evaluation Review, , vol. 24(3), pages 251-271, June.
    15. Margaret L. Brandeau, 2016. "Creating impact with operations research in health: making room for practice in academia," Health Care Management Science, Springer, vol. 19(4), pages 305-312, December.
    16. Iluminada Fuertes-Fuertes & J. David Cabedo & Inmaculada Jimeno-García, 2019. "Capturing the Invisible Wealth in Nonprofits to Overcome Myopic Perceptions," Sustainability, MDPI, vol. 12(1), pages 1-18, December.
    17. Martin A. Andresen & Ehsan Jozaghi, 2012. "The Point of Diminishing Returns: An Examination of Expanding Vancouver’s Insite," Urban Studies, Urban Studies Journal Limited, vol. 49(16), pages 3531-3544, December.
    18. Sabina S Alistar & Douglas K Owens & Margaret L Brandeau, 2014. "Effectiveness and Cost Effectiveness of Oral Pre-Exposure Prophylaxis in a Portfolio of Prevention Programs for Injection Drug Users in Mixed HIV Epidemics," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-11, January.
    19. Elisa F. Long & Naveen K. Vaidya & Margaret L. Brandeau, 2008. "Controlling Co-Epidemics: Analysis of HIV and Tuberculosis Infection Dynamics," Operations Research, INFORMS, vol. 56(6), pages 1366-1381, December.
    20. Ruixuan Liu & Zhengfei Yu, 2019. "Accelerated Failure Time Models with Log-concave Errors," Tsukuba Economics Working Papers 2019-003, Faculty of Humanities and Social Sciences, University of Tsukuba.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:inm:ormnsc:v:46:y:2000:i:8:p:1013-1031. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Chris Asher (email available below). General contact details of provider: https://edirc.repec.org/data/inforea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.