A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence

作者：Gisev Natasa^*; Shanahan Marian; Weatherburn Don J; Mattick Richard P; Larney Sarah; Burns Lucy; Degenhardt Louisa

来源：Addiction, 2015, 110(12): 1975-1984.

DOI：10.1111/add.13073

• Cost-effectiveness
• data linkage
• mortality
• opioid substitution treatment
• opioid-related disorders
• prisons

AimAlthough opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6months post-release.
DesignPopulation-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011).
SettingNew South Wales, Australia.
ParticipantsA cohort of 16073 people with a history of opioid dependence released from prison for the first time between 1January 2000 and 30June 2011.
InterventionOST treatment compared to no OST treatment at prison release.
MeasurementsMortality and costs (treatment, criminal justice systemcourt, penalties, prisonand the social costs of crime) were evaluated at 6months post-release. Analyses included propensity score matching, bootstrapping and regression.
FindingsA total of 13468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.
ConclusionOpioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6months of release.

• 出版日期2015-12