A cost‐effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence. (23rd September 2015)

• Record Type: Journal Article
• Authors: Gisev, Natasa; Shanahan, Marian; Weatherburn, Don J.; Mattick, Richard P.; Larney, Sarah; Burns, Lucy; Degenhardt, Louisa
• Is Part Of: Addiction. Volume 110:Number 12(2015:Dec.)
• Page Start: 1975
• Page End: 1984
• Publication Date: 2015-09-23
• Subjects: Cost‐effectiveness -- data linkage -- mortality -- opioid substitution treatment -- opioid‐related disorders -- prisons; Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.13073
• Languages: English
• ISSNs: 0965-2140

Abstract

Abstract: Aim: Although 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 6 months post‐release. Design: Population‐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). Setting: New South Wales, Australia. Participants: A cohort of 16 073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011. Intervention: OST treatment compared to no OST treatment at prison release. Measurements: Mortality and costs (treatment, criminal justice system—court, penalties, prison—and the social costs of crime) were evaluated at 6 months post‐release. Analyses included propensity score matching, bootstrapping and regression. Findings: A total of 13 468 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 $14 356). 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. Conclusion: Opioid 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 6 months of release.