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Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost‐effectiveness analysis
Author(s) -
Stephen James H.,
Halpern Casey H.,
Barrios Cristian J.,
Balmuri Usha,
Pisapia Jared M.,
Wolf John A.,
Kampman Kyle M.,
Baltuch Gordon H.,
Caplan Arthur L.,
Stein Sherman C.
Publication year - 2012
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/j.1360-0443.2011.03656.x
Subject(s) - heroin , deep brain stimulation , medicine , quality of life (healthcare) , methadone maintenance , methadone , psychiatry , drug , disease , nursing , parkinson's disease
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%.