Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail.

Abstract

BACKGROUND:

Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group.

METHODS:

We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective.

RESULTS:

The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs.

CONCLUSIONS:

IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.

• Authors: Gary A Zarkin, Stephen Orme, Laura J Dunlap, Sharon M Kelly, Shannon G Mitchell, Kevin E O'Grady, Robert P Schwartz
• Journal: Drug and alcohol dependence (Drug Alcohol Depend) Vol. 217 Pg. 108292 (12 01 2020) ISSN: 1879-0046 [Electronic] Ireland
• PMID: 32992151 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Analgesics, Opioid
• Methadone

Topics

• Adult
• Analgesics, Opioid (economics, therapeutic use)
• Cost-Benefit Analysis (methods)
• Female
• Humans
• Jails (economics)
• Male
• Methadone (economics, therapeutic use)
• Middle Aged
• Opiate Substitution Treatment (economics, methods)
• Opioid-Related Disorders (drug therapy, economics)
• Patient Acceptance of Health Care
• Patient Navigation (economics, methods)
• Treatment Outcome