Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.
Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA.
Harm Reduct J. 2018 May 23;15(1):28. doi: 10.1186/s12954-018-0234-x.
Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns.
We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates.
The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose.
The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.
墨西哥最近颁布了毒品政策改革法案，将少量非法毒品持有行为非刑罪化，并要求警方将已确认的药物使用者转介至戒毒治疗机构。然而，毒品治疗扩张的经济影响尚不确定。我们评估了墨西哥提华纳市（毒品使用和艾滋病毒是主要公共卫生问题）提供阿片类药物替代疗法（OST）的成本。
我们采用经济医疗服务提供者的视角，并采用基于成分的微观成本法来量化墨西哥提华纳市两家提供者（一家私立和一家公立）提供 OST（美沙酮维持治疗）的平均每月成本。成本按投入类型（资本、经常性人员和非人员）进行划分。我们将“交付成本”定义为美沙酮以外的所有成本，并比较了粉末形式和胶囊形式美沙酮的总成本。成本数据来自对高级员工的访谈和支出报告的审查。服务提供数据来自活动日志和高级员工访谈。结果是每个 OST 接触者的成本和每个 OST 月的人均成本。我们还从已发表的费率中收集了 OST 提供的患者收费信息。
私立和公立机构的每个 OST 接触者的总成本分别为 3.12 美元和 5.90 美元，相应的 OST 人均月费用分别为 95 美元和 179 美元。两个地点的美沙酮交付成本（每个 OST 接触者 2.78 美元私人和 3.46 美元公共）相似。然而，美沙酮本身的成本差异很大（私人机构每 80 毫克剂量为 0.34 美元，公共机构为 2.44 美元）。患者每剂量美沙酮收费 1.93-2.66 美元。
墨西哥的 OST 提供成本与其他中上收入国家一致。然而，墨西哥仍有大多数注射毒品者无法负担基于证据的（OST）戒毒治疗设施。
