METHADONE FOR ADDICTS COULD SLOW SPREAD OF HIV, STUDY FINDS

Methadone maintenance treatment for injection drug users is a highly
cost-effective way to combat the spread of HIV, according to a study
just released by researchers from the Department of Veterans Affairs
and Stanford University.

"If health care plans evaluated methadone like any another
pharmaceutical, they would include it as a benefit because it is so
very cost-effective," said lead author Greg Zaric, a former Stanford
graduate student, "But many health plans do not provide this coverage."

More than one million people inject drugs in the U.S., but there is
room for only 115,000 people in methadone treatment programs. Eight
states have laws that prohibit methadone treatment of addiction.

In an article appearing in the July issue of the American Journal of
Public Health, the researchers found that expansion in the capacity of
U.S. methadone maintenance programs would result in significant health
benefits to those in treatment as well as to the general population.
Treatment expansion would reduce the spread of HIV to the general
population. This effect is so significant that most of its health
benefit of treatment expansion would be realized by people who are not
in methadone maintenance and do not inject drugs.

The authors report that barriers to methadone, including excessive
regulation and its exclusion from private and public health plans, are
denying addicted individuals a cost-effective therapy.

The findings emerged from a dynamic model of the HIV epidemic based on
extensive review of literature on methadone effectiveness, HIV
transmission and health care costs. The model was used to simulate how
methadone expansion would affect total health care costs, the spread
of HIV, and the number of quality-adjusted years of life experienced
by treated and untreated heroin users, the people they contact, and
the rest of the population.

Expansion of methadone programs would be highly cost-effective in
communities like New York, where 40 percent of injection drug users
are HIV infected. Treatment expansion would be only slightly less
cost-effective in communities like Los Angeles, where only 5 percent
of injection drug users are HIV infected. The study estimated that
expansion of methadone treatment capacity would cost between $8,200
and $10,900 for every quality-adjusted life year gained. This
cost-effectiveness ratio is substantially lower than that of many
widely used medical care interventions, and well below the frequently
used threshold of judging health care interventions, which is $50,000
per quality-adjusted life year gained.

The authors conclude that, even though methadone maintenance does not
lead to a complete or permanent cessation of drug use, it is a
cost-effective way of slowing the spread of HIV.

This research was conducted by a team from the V.A. Palo Alto Health
Care System and Stanford University, with support from the National
Institute on Drug Abuse.

The report was authored by Zaric, Paul G. Barnett and Margaret L.
Brandeau. Zaric was employed by the Veterans Administration while a
graduate student at Stanford. He is now assistant professor at the
Ivey School of Business at the University of Western Ontario. Barnett
is Health Economist in the V.A. Cooperative Studies Program and
Director of the V.A. Health Economics Resource Center in Menlo Park,
California.