Tran Bach Xuan, Ohinmaa Arto, Duong Anh Thuy, Do Nhan Thi, Nguyen Long Thanh, Mills Steve, Houston Stan, Jacobs Philip
School of Public Health, University of Alberta, Edmonton, Canada.
AIDS Care. 2012;24(3):283-90. doi: 10.1080/09540121.2011.608420. Epub 2011 Sep 22.
Methadone maintenance treatment (MMT) is efficacious in reducing drug use that may improve HIV/AIDS care and treatment outcomes. This study evaluated the incremental cost-effectiveness of MMT for HIV-positive drug users from the perspective of health service providers. A sample of 370 HIV-positive drug users (age: mean ± SD: 29.5 ± 5.9 years; 95.7% male) taking MMT in multi-sites was assessed at baseline, three, six and nine months. Costs of MMT services were analyzed and converted to the year 2009. Quality-adjusted life years (QALYs) were modeled from changes in health-related quality of life of patients using the modified World Health Organization Quality of Life - Brief Version (WHOQOL-BREF). Inverse probability-of-treatment weights, constructed using propensity score of non-responses, were applied to adjust for potential confounding. Over nine months, MMT substantially improved QALYs of HIV/AIDS patients (0.076 QALY [0.066-0.084]). The increments in QALY were large and stabilized in those patients taking antiretroviral treatment and abstinent to drug use. For one QALY gained, the MMT program would cost US$3745.3, approximately 3.2 times Vietnam GDP per capita in 2009. The cost-effectiveness of MMT intervention was robust against HIV advanced status or co-morbidity, e.g., TB treatment, but it might not be cost-effective for those patients who continued to use drug. Findings of this study indicate that providing MMT for HIV-positive drug users is a cost-effective intervention in Vietnam. Integrating MMT to HIV/AIDS care and treatment services would be beneficial in injection-driven HIV epidemics.
美沙酮维持治疗（MMT）在减少药物使用方面是有效的，这可能会改善艾滋病毒/艾滋病的护理和治疗结果。本研究从卫生服务提供者的角度评估了MMT对艾滋病毒阳性吸毒者的增量成本效益。对多地点接受MMT治疗的370名艾滋病毒阳性吸毒者（年龄：均值±标准差：29.5±5.9岁；95.7%为男性）在基线、3个月、6个月和9个月时进行了评估。分析了MMT服务的成本并换算为2009年的成本。使用改良的世界卫生组织生活质量简表（WHOQOL - BREF）根据患者健康相关生活质量的变化对质量调整生命年（QALYs）进行建模。使用无应答倾向得分构建的治疗逆概率权重用于调整潜在的混杂因素。在九个月的时间里，MMT显著改善了艾滋病毒/艾滋病患者的QALYs（0.076 QALY [0.066 - 0.084]）。在接受抗逆转录病毒治疗且戒毒的患者中，QALY的增量很大且趋于稳定。每获得一个QALY，MMT项目将花费3745.3美元，约为2009年越南人均国内生产总值的3.2倍。MMT干预的成本效益对于艾滋病毒晚期状态或合并症（如结核病治疗）具有稳健性，但对于那些继续吸毒的患者可能不具有成本效益。本研究结果表明，为艾滋病毒阳性吸毒者提供MMT在越南是一种具有成本效益的干预措施。将MMT纳入艾滋病毒/艾滋病护理和治疗服务在以注射为主导的艾滋病毒流行中是有益的。
