Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost-effectiveness analysis.

Abstract

AIMS:

To determine the success threshold at which a theoretical course of deep brain stimulation (DBS) would provide the same quality of life (QoL) and cost-effectiveness for heroin dependence as methadone maintenance treatment (MMT).

DESIGN:

We constructed a decision analysis model to calculate QoL after 6 months of MMT and compared it to a theoretical course of DBS. We also performed a cost-effectiveness analysis using societal costs of heroin dependence, MMT and DBS.

SETTING:

Systematic literature review and meta-analysis.

PARTICIPANTS:

Patients (n = 1191) from 15 trials administering 6 months of MMT and patients (n = 2937) from 45 trials of DBS for movement disorders.

MEASUREMENTS:

Data on QoL before and after MMT, retention in MMT at 6 months, as well as complications of DBS and their impact on QoL in movement disorders.

FINDINGS:

We found a QoL of 0.633 (perfect health = 1) in heroin addicts initiating MMT. Sixty-six per cent of patients completed MMT, but only 47% of them had opiate-free urine samples, resulting in an average QoL of 0.7148 (0.3574 quality-adjusted life years (QALYs) over 6 months). A trial of DBS is less expensive ($81,000) than untreated (or relapsed) heroin dependence ($100,000), but more expensive than MMT ($58,000). A theoretical course of DBS would need a success rate of 36.5% to match MMT, but a success rate of 49% to be cost-effective.

CONCLUSIONS:

The success rate, defined as the percentage of patients remaining heroin-free after 6 months of treatment, at which deep brain stimulation would be similarly cost-effective in treating opiate addiction to methadone maintenance treatment, is estimated at 49%.

• Authors: James H Stephen, Casey H Halpern, Cristian J Barrios, Usha Balmuri, Jared M Pisapia, John A Wolf, Kyle M Kampman, Gordon H Baltuch, Arthur L Caplan, Sherman C Stein
• Journal: Addiction (Abingdon, England) (Addiction) Vol. 107 Issue 3 Pg. 624-34 (Mar 2012) ISSN: 1360-0443 [Electronic] England
• PMID: 21919988 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Chemical References

• Narcotics
• Methadone

Topics

• Clinical Trials as Topic
• Cost-Benefit Analysis
• Decision Support Techniques
• Deep Brain Stimulation (economics, methods)
• Heroin Dependence (economics, rehabilitation)
• Humans
• Methadone (economics, therapeutic use)
• Narcotics (economics, therapeutic use)
• Quality of Life
• Quality-Adjusted Life Years