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Addiction. 2020 Mar;115(3):437-450. doi: 10.1111/add.14797. Epub 2019 Oct 29.

Cost-effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: dynamic modeling analysis.

Author information

1
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
2
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
3
Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
4
Department of Statistics and Data Science, Yale University, New Haven, CT, USA.
5
Yale School of Management, New Haven, CT, USA.
6
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
7
Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
8
University of Malaya, Kuala Lumpur, Malaysia.

Abstract

BACKGROUND AND AIMS:

Although opioid agonist treatment (OAT) for opioid use disorder (OUD) is cost-effective in settings where the HIV epidemic is concentrated among people who inject drugs, OAT coverage in Ukraine remains far below internationally recommended targets. Scale-up is limited by both OAT availability and demand. This study aimed to evaluate the cost-effectiveness of a range of plausible OAT scale-up strategies in Ukraine incorporating the potential impact of treatment spillover and the real-world demand for addiction treatment.

DESIGN, SETTING AND PARTICIPANTS:

Ten-year horizon (2016-25) modeling study of opioid addiction epidemic and treatment that accommodated potential peer effects in opioid use initiation and supply-induced treatment demand in three Ukrainian cities: Kyiv, Mykolaiv and Lviv, comprising a simulated population of people at risk of and with OUD.

MEASUREMENTS:

Incremental cost per quality-adjusted life-year gained in the simulated population.

FINDINGS:

An estimated 12.2-, 2.4- and 13.4-fold OAT capacity increase over 2016 baseline capacity in Kyiv, Mykolaiv and Lviv, respectively, would be cost-effective at a willingness-to-pay of one per-capita gross domestic product (GDP) per quality-adjusted life-year gained. This result is robust to parametric and structural uncertainty. Even under the most ambitious capacity increase, OAT coverage (i.e. the proportion of people with OUD receiving OAT) over a 10-year modeling horizon would be 20, 11 and 17% in Kyiv, Mykolaiv and Lviv, respectively, owing to limited demand.

CONCLUSIONS:

It is estimated that a substantial increase in opioid agonist treatment (OAT) capacity in three Ukrainian cities would be cost-effective for a wide range of willingness-to-pay thresholds. Even a very ambitious capacity increase, however, is unlikely to reach internationally recommended coverage levels. Further increases in coverage may be limited by demand and would require addressing existing structural barriers to OAT access.

KEYWORDS:

Buprenorphine; Eastern Europe; economic evaluation; injection initiation; methadone; opioid epidemic; people who inject drugs (PWID); treatment as prevention; treatment demand; treatment waiting-list

PMID:
31478285
PMCID:
PMC7015766
[Available on 2021-03-01]
DOI:
10.1111/add.14797

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