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A cost‐effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence
Author(s) -
Gisev Natasa,
Shanahan Marian,
Weatherburn Don J.,
Mattick Richard P.,
Larney Sarah,
Burns Lucy,
Degenhardt Louisa
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13073
Subject(s) - prison , medicine , propensity score matching , opiate substitution treatment , population , demography , cohort , psychiatry , opioid , buprenorphine , psychology , environmental health , criminology , receptor , sociology
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.