A Cost-Effectiveness Analysis of Opioid Substitution Therapy Upon Prison Release in Reducing Mortality among People with a History of Opioid Dependence

Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost-effectiveness of treatment has not been examined. Therefore, we undertook a cost-effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post-release.

Design: Population-based, retrospective data linkage study using records of OST entrants (1985-2010), charges and court appearances (1993-2011), prison episodes (2000-11) and death notifications (1985-2011).

Participants: A cohort of 16 073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011.

Intervention: OST treatment compared to no OST treatment at prison release.

Measurements: Mortality and costs (treatment, criminal justice system-court, penalties, prison-and the social costs of crime) were evaluated at 6 months post-release. Analyses included propensity score matching, bootstrapping and regression.

A total of 13 468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post-release ($7206 versus $14 356). The incremental cost-effectiveness ratio showed that OST post-release was dominant, incurring lower costs and saving more lives. The probability that OST post-release is cost-effective per life-year saved is 96.7% at a willingness to pay of $500.

Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost-effective in reducing mortality in the first 6 months of release.

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By:  Gisev N1, Shanahan M1, Weatherburn DJ2, Mattick RP1, Larney S1,3, Burns L1, Degenhardt L1,4.

• 1National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.
• 2New South Wales Bureau of Crime Statistics and Research (BOCSAR), Sydney, New South Wales, Australia.
• 3Alpert Medical School, Brown University, Providence, Rhode Island, USA.
• 4School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. 

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