RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
RTI, International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194, United States.
Drug Alcohol Depend. 2020 Dec 1;217:108292. doi: 10.1016/j.drugalcdep.2020.108292. Epub 2020 Sep 16.
Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group.
We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective.
The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs.
IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.
从审前拘留所获释的阿片类药物使用障碍（OUD）个体有很高的阿片类药物复发风险。虽然已经研究了几种在监禁期间开始的 OUD 干预措施，但很少有对其进行经济评估。作为一项三臂随机试验的一部分，我们评估了阴性尿液阿片检测的成本和成本效益。囚犯被分配到监狱中的中期美沙酮（IM），并在释放后继续接受美沙酮治疗，同时有无 3 个月的释放后患者导航（PN），与强化常规治疗组进行比较。
我们从提供者的角度实施微观成本核算方法，以估算每个参与者在监狱中的成本以及从监狱释放后的 12 个月的成本。经济数据包括监狱内和社区内的服务利用情况、自我报告的医疗保健利用情况和司法系统参与情况以及行政逮捕记录。我们的结果衡量指标是在 12 个月随访时具有阴性阿片类药物尿液检测结果的参与者人数。我们仅计算干预成本和从社会角度计算的成本的增量成本效益比（ICER）。
从监狱开始并持续到社区的每个参与者提供患者导航服务的平均成本为 283 美元。我们发现，IM 被 ETAU 和 IM + PN 所主导。每增加一个具有阴性阿片类药物尿液检测结果的参与者，仅包括干预成本的 IM + PN 的 ICER 为 91 美元，包括社会成本的 ICER 为 305 美元。
从干预提供者和社会角度来看，IM + PN 几乎肯定是具有成本效益的选择。
