Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Addiction. 2020 Mar;115(3):437-450. doi: 10.1111/add.14797. Epub 2019 Oct 29.
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.
Incremental cost per quality-adjusted life-year gained in the simulated population.
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.
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.
尽管阿片类药物使用障碍（OUD）的阿片类激动剂治疗（OAT）在 HIV 流行集中在注射毒品人群的环境中具有成本效益，但乌克兰的 OAT 覆盖率仍远低于国际建议目标。规模扩大受到 OAT 供应和需求的限制。本研究旨在评估一系列在乌克兰扩大 OAT 规模的策略的成本效益，这些策略考虑了治疗溢出的潜在影响以及现实世界对成瘾治疗的需求。
设计、设置和参与者：这是一项针对阿片类药物成瘾流行和治疗的 10 年（2016-25 年）建模研究，该研究考虑了在乌克兰三个城市（基辅、尼古拉耶夫和利沃夫）中阿片类药物使用开始时的潜在同伴效应以及供应诱导的治疗需求对治疗的影响，涵盖了有 OUD 风险和患有 OUD 的人群。
在模拟人群中每获得一个质量调整生命年的增量成本。
与 2016 年基线能力相比，在基辅、尼古拉耶夫和利沃夫，OAT 能力分别增加 12.2、2.4 和 13.4 倍，在愿意支付一个人均国内生产总值（GDP）的支付意愿下，将具有成本效益每获得一个质量调整生命年。这一结果对参数和结构不确定性具有稳健性。即使在最雄心勃勃的能力增加情况下，在 10 年建模期间，OAT 的覆盖率（即接受 OAT 的 OUD 患者比例）也将分别达到基辅、尼古拉耶夫和利沃夫的 20%、11%和 17%，这是由于需求有限。
据估计，在乌克兰三个城市大幅增加阿片类激动剂治疗（OAT）的能力将在广泛的支付意愿范围内具有成本效益。然而，即使是非常雄心勃勃的能力增加，也不太可能达到国际建议的覆盖水平。进一步提高覆盖率可能会受到需求的限制，并且需要解决 OAT 准入的现有结构障碍。
