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Price, cost and value of opiate detoxification treatments: Reanalysis of data from two randomised trials

  • Michael Gossop (a1) and John Strang (a1)

Abstract

Background

Treatments in different settings have different costs. A dilemma arises if expensive treatments lead to better outcomes.

Aims

To investigate conflicts between the priorities of cost minimisation, clinical effectiveness, and cost-effectiveness in the detoxification of opiate addicts.

Method

Cost and clinical effectiveness were examined using published outcome data. The main outcome measures were: achieving a drug-free state on completion of detoxification; the economic costs of treatment.

Results

In terms of simple cost, in-patient detoxification is much more expensive than out-patient treatment (ratio, 24:1). With adjustment for successful outcome, the costs are almost identical (ratio, 0.9:1). Comparison of specialist and general psychiatry in-patient settings showed that even when adjusted for clinical outcomes, the specialist setting is more costly (ratio, 1.9:1), although the outcomes are better.

Conclusions

Naïve adherence to cost and cost-containment considerations is dangerous. Discussion of treatment costs is misleading if not informed by, and adjusted for, evidence of effectiveness. This is especially important where marked differences in outcome between treatment options exist.

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Copyright

Corresponding author

Professor M. Gossop, National Addiction Centre, 4 Windsor Walk, London SE5 8AF, UK

Footnotes

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Declaration of interest

Partial funding from the Medical Research Council.

Footnotes

References

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Bearn, J., Gossop, M. & Strang, J. (1996) A randomised double-blind comparison of lofexidine and methadone in inpatient treatment of opiate withdrawal. Drug and Alcohol Dependence, 43, 8791.
Beam, J., Gossop, M. & Strang, J. (1998) Accelerated lofexidine treatment regimen compared with conventional lofexidine and methadone treatment for inpatient opiate detoxification. Drug and Alcohol Dependence, 50, 227232.
Bradley, B. P., Phillips, G., Green, L., et al (1989) Circumstances surrounding the initial lapse to opiate use following detoxification. British Journal of Psychiatry, 154, 354359.
Central Drugs Coordinating Unit (1998) Tackling Drugs to Build a Better Britain: The Government's 10-Year Strategy for Tackling Drug Misuse. London: HMSO.
Cochrane, A. (1972) Effectiveness and Efficiency. London: Nuffield Provincial Hospitals Trust.
Dawe, S., Gossop, M., Griffiths, P., et al (1991) Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules. British Journal of Addiction, 86, 977982.
Gossop, M., Johns, A. & Green, L. (1986) Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment. British Medical Journal, 293, 103104.
Gossop, M., Green, L., Phillips, G., et al (1989) Lapse, relapse and survival among opiate addicts: a prospective follow-up study. British Journal of Psychiatry, 154, 348353.
Gossop, M., Griffiths, P., Bradley, B., et al (1989) Opiate withdrawal symptoms in response to 10-day and 21-day methadone withdrawal programmes. British Journal of Psychiatry, 154, 360363.
Gossop, M., & Strang, J. (1990) A comparison of the withdrawal responses of heroin and methadone addicts during detoxification. British Journal of Psychiatry, 158, 697699.
Gossop, M., Marsden, J., Stewart, D., et al (1997) The National Treatment Outcome Research Study in the United Kingdom: six month follow-up outcomes. Psychology of Addictive Behaviors, 11, 324337.
Gossop, M., Marsden, J., Stewart, D., et al (1998) Substance use, health and social problems of service users at 54 drug treatment agencies. Intake data from the National Treatment Outcome Research Study. British Journal of Psychiatry, 173, 166171.
Healy, A., Knapp, M., Astin, J., et al (1998) The economic burden of drug addiction: social costs incurred by clients at intake to the National Treatment Outcome Research Study (NTORS). British Journal of Psychiatry, 173, 160165.
Honigsbaum, F., Richards, J. & Lockett, T. (1995) Priority Setting in Action: Purchasing Dilemmas. Oxford: Radcliffe Medical Press.
Lockett, T. (1997) Evidence-based and Cost-effective Medicine for the Uninitiated. Oxford: Radcliffe Medical Press.
Phillips, G. T., Gossop, M. & Bradley, B. (1987) An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21-day inpatient methadone detoxification procedure. Addictive Behaviors, 12, 16.
Powell, J., Dawe, S., Richards, D., et al (1993) Can opiate addicts tell us about their relapse risk? Subjective predictors of clinical prognosis. Addictive Behaviors, 18, 473490.
Single, E., Robson, L., Xie, X., et al (1998) The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Addiction, 93, 991–106.
Strang, J. & Gossop, M. (1990) Comparison of linear versus inverse exponential methadone reduction curves in the detoxification of opiate addicts. Addictive Behaviors, 15, 541547.
Strang, J., Marks, I., Dawe, S., et al (1997) Type of hospital setting and treatment outcome with heroin addicts. Results from a randomised trial. British Journal of Psychiatry, 171, 335339.
Swift, R. M. & Miller, N. S. (1997) Integration of health care economics for addiction treatment in clinic care. Journal of Psychoactive Drugs, 29, 255262.
Unnithan, S., Gossop, M. & Strang, J. (1992) Factors associated with relapse among opiate addicts in an outpatient detoxification programme. British Journal of Psychiatry, 161, 654657.

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Price, cost and value of opiate detoxification treatments: Reanalysis of data from two randomised trials

  • Michael Gossop (a1) and John Strang (a1)
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