Overall , the cohort Markov models remain the most popular approach , followed by decision trees , Individual based model and System dynamics model ( SD ) .
Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions
Background The overarching goal of health policies is to maximize health and societal benefits .
Economic evaluations can play a vital role in assessing whether or not such benefits occur .
This paper review s the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to ( i ) modelling paradigms themselves ; ( ii ) perspectives of costs and benefits and ( iii ) time frame .
A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting
Abstract Background and aim : Buprenorphine offers an alternative to methadone in the treatment of heroin dependence , and has the advantage of allowing alternate-day dosing . This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a r and omised trial . Study design and methods : The study was a r and omised , open-label , 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone . Those who were currently on a methadone program ( n = 57 ; continuing therapy subgroup ) were analysed separately from new treatment recipients ( n = 82 ; initial therapy subgroup ) . The study took a broad societal perspective and included health , crime and personal costs . Data on re source use and outcomes were a combination of clinical records and self report at interview . The main outcomes were incremental cost per additional day free of heroin use and per QALY . An analysis of uncertainty calculated the likelihood of net benefits for a range of acceptable money values of outcomes . All costs were in 1999 Australian dollars ( $ A ) . Results : The estimated mean number of heroin-free days did not differ significantly between those r and omised to methadone ( 225 [ 95 % CI 91 , 266 ] ) , or buprenorphine ( 222 [ 95 % CI 194 , 250 ] ) over the year of the trial . Buprenorphine was associated with an average 0.03 greater QALYs over 52 weeks ( not significant ) . The total cost was $ A17 736 ( 95 % CI −$A2981 , $ A38 364 ) with methadone and $ A11 916 ( 95 % CI $ A7697 , $ A16 135 ) with buprenorphine ; costs excluding crime were $ A4513 ( 95 % CI $ A3495 , $ A5531 ) and $ A5651 ( 95 % CI $ A4202 , $ A7100 ) . With additional heroin-free days as the outcome , and crime costs included buprenorphine has a lower cost but less heroin-free days . If crime costs are excluded buprenorphine has a higher cost and worse outcome than methadone . With additional QALYs as the outcome , the cost effectiveness of buprenorphine is $ A39 404 if crime is excluded , but buprenorphine is dominant if crime is included . Conclusions : The trial found no significant differences in costs or outcomes between methadone and buprenorphine maintenance in this particular setting . Although some of the results suggest that methadone may have a cost advantage , it is difficult to infer from the trial data that offering buprenorphine as an alternative would have a significant effect on total costs or outcomes . The point estimates of costs and outcomes suggest that buprenorphine may have an advantage in those initiating therapy . The confidence intervals were wide , however , and the likelihood of net benefits from substituting one treatment for another was close to 50 %
Overall , the cohort Markov models remain the most popular approach , followed by decision trees , Individual based model and System dynamics model ( SD ) .
Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions
Background The overarching goal of health policies is to maximize health and societal benefits .
Economic evaluations can play a vital role in assessing whether or not such benefits occur .
This paper review s the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to ( i ) modelling paradigms themselves ; ( ii ) perspectives of costs and benefits and ( iii ) time frame .