The reductions in monetary cost and gains in productivity with methadone maintenance treatment: One year follow-up

Highlights

• The average cost was decreased by 60% at one-year follow-up for MMT.

• The mean number of months of unemployment significantly dropped.

• But limited gains were seen with regard to their QOL at this follow-up study.

Abstract

While methadone maintenance treatment (MMT) is beneficial for heroin dependence, there is little information regarding the reductions in monetary cost and gains in productivity following MMT. The aim of this study was to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT. Twenty-nine participants from an MMT clinic were included. The monetary cost, productivity, quality of life (QOL) and mental health status were assessed at both baseline and one year follow-up. The average annual total cost was approximately US$26,485 (1.43 GDP per capita in 2010) at baseline, and decreased by 59.3% to US$10,784 (0.58 GDP) at follow-up. The mean number of months of unemployment dropped from 6.03 to 2.79, the mean income increased to exceed the basic salary, but only reached 45.3% of the national average monthly earnings. The participants׳ mental health improved, but their QOL scores did not increase significantly. After one year of MMT, the monetary cost of heroin addiction fell, both the productivity and mental health of the participants׳ improved, but limited gains were seen with regard to their QOL.

Introduction

Heroin is one of the most prevalent used illicit drugs worldwide (Degenhardt et al., 2011), and the use of opioids (heroin, opium and prescription opioids) has increased in Asia since 2009 (United Nations Office on Drugs and Crime, 2013). In Taiwan, heroin has been the most commonly abused drug for more than a decade, accounting for 79.9% of illicit drug use in 2011 (Chi et al., 2013). The impacts of opioid dependence include a high prevalence of virus infections due to needle-sharing, such as the human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) (Mathers et al., 2008, Chu et al., 2009, Nelson et al., 2011); co-morbid psychiatric illness (Brooner et al., 1997, Kidorf et al., 2004, Fan et al., 2014); high criminal behavior (Degenhardt et al., 2013a); and low employment (French et al., 2001, DeSimone, 2002). These consequences cause heavy social and economic burdens, even when using different approaches to evaluate the related costs. For example, opioids were the most significant contributor to the 20 million disability-adjusted life years (DALYs) caused by illicit drugs worldwide in 2010, according to a recent cost utility analysis (Degenhardt et al., 2013b). Costs of illness studies establish values for illnesses, health care services and programs by identifying the cost-generating components and attributing a monetary value to them. The monetary value is the “opportunity cost” of the forgone opportunity to use in a different way those resources that are used or lost due to illness (Hodgson and Meiners, 1982). The annual cost of substance abuse or addiction in specific countries has been estimated in monetary terms (Healey et al., 1998, Single et al., 1998, Xie et al., 1998, Yu et al., 1998, Cartwright, 1999, Mark et al., 2001, Fenoglio et al., 2003, Cartwright, 2008, Wickizer, 2013), ranging from US$ 0.3 to 143 billion per year, with the cost of heroin addiction being estimated to be US$ 21.9 billion in the USA (Mark et al., 2001). Although the monetary cost of heroin addiction might vary across countries and studies, the proportions of the Gross Domestic Product (GDP) per capita are comparable across studies and geographic regions, at around 0.11–0.29% (Lin et al., 2013a), and high productivity losses were noted (Yu et al., 1998, Cartwright, 2008). The productivity losses from heroin addiction might be due to premature death, unemployment and incarceration, and it has been found that such losses account for about 30% of the total cost, more than the medical costs, not including those related to premature death (Mark et al., 2001, Lin et al., 2013a).

Methadone maintenance treatment (MMT) is a common and effective treatment for heroin addiction (Barnett, 1999, Mattick et al., 2009). The benefits of MMT include reductions in mortality (Huang et al., 2011) and HIV-related risk behavior (Corsi et al., 2009, Department of Health, Ministry of Justice, Ministry of Education, Ministry of Foreign Affair, 2010, Chen et al., 2012), and improvements in quality of life (QOL) (Xiao et al., 2010, Wang et al., 2012). In Taiwan, an MMT pilot project started in six clinics in 2005, and was extended to 136 clinics across the country by the end of June 2013, with 42,431 patients receiving the treatment in total (Center for Disease Control (Taiwan), 2014). However, previous research has shown that only 40–50% of MMT users remain in such programs for more than one year without dropping out (Gossop et al., 2001), and it has also been reported that pay-for-treatment programs have high drop-out rates (Booth et al., 2004). Although National Health Insurance is not reimbursed for MMT, it is funded by the local government, and the one-year retention rate for such treatment is 41.6% (Lin et al., 2013). MMT has been widely researched in North America and Europe, and there is now a growing body of literature on MMT-related issues in Taiwan (Huang et al., 2011, Yen et al., 2011, Chen et al., 2012, Lee et al., 2012, Wang et al., 2012, Chen et al., 2013, Lin et al., 2013, Lin et al., 2013a, Wang et al., 2013). However, information regarding the changes in monetary cost and productivity following MMT is relatively limited. The aim of this study was therefore to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT in Taiwan.