An Economic Evaluation of Contingency Management for Completion of Hepatitis B Vaccination in Those on Treatment for Opiate Dependence

AIMS:

To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of healthcare resources.

DESIGN:

A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and healthcare cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection.

SETTINGS AND PARTICIPANTS:

Data on attendance to vaccination from a UK cluster randomised trial.

INTERVENTION:

Two contingency management options were examined in the trial: fixed vs. escalating schedule financial incentives.

MEASUREMENT:

Lifetime healthcare costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios.

FINDINGS:

The resulting estimate for the incremental lifetime healthcare cost of the contingency management strategy versus usual care was £22 (95% CI: -£12 to £40) per person offered the incentive. For 1,000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI: 8 to 30). The probabilistic incremental cost per quality adjusted life year gained of the contingency management programme was estimated to be £6,738 (95% CI: £6,297 to £7,172), with an 89% probability of being considered cost-effective at a threshold of £20,000 per quality-adjusted life years gained (98% at £30,000).

CONCLUSIONS:

Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of healthcare resources in the UK as long as the incidence remains above 1.2%.

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By:  Rafia R1, Dodd PJ1, Brennan A1, Meier PS2, Hope VD3, Ncube F3, Byford S4, Tie H4, Metrebian N5, Hellier J6, Weaver T7, Strang J5.

• 1Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield.
• 2Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield.
• 3Injecting Drug Use Team, HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE).
• 4Centre for the Economics of Mental and Physical Health, King's College London.
• 5National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
• 6Department of Biostatistics, King's College London.
• 7Department of Mental Health, Social work and Integrative Medicine, Middlesex University. 
• Addiction. 2016 Mar 18. doi: 10.1111/add.13385. 

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Impact of Cannabis Use During Stabilization on Methadone Maintenance Treatment

Background and Objectives

Illicit drug use, particularly of cannabis, is common among opiate-dependent individuals, and has the potential to impact treatment in a negative manner.

Methods

To examine this, patterns of cannabis use prior to and during methadone maintenance treatment (MMT) were examined to assess possible cannabis-related effects on MMT, particularly during methadone stabilization. Retrospective chart analysis was used to examine outpatient records of patients undergoing MMT (n=91), focusing specifically on past and present cannabis use and its association with opiate abstinence, methadone dose stabilization, and treatment compliance.

Results

Objective rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization. History of cannabis use correlated with cannabis use during MMT, but did not negatively impact the methadone induction process. Pilot data also suggested that objective ratings of opiate withdrawal decrease in MMT patients using cannabis during stabilization.

Conclusions and Scientific Significance

The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid-opioid system interactions.

Full article at:   http://goo.gl/hFf8AP

By:  Jillian L. Scavone, PhD,1 Robert C. Sterling, PhD,2 Stephen P. Weinstein, PhD,2 and Elisabeth J. Van Bockstaele, PhD1

¹Department of Neuroscience, Farber Institute for Neurosciences (http://www.jefferson.edu/university/farber_institute.html), Thomas Jefferson University, Philadelphia, Pennsylvania

²Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania

Address correspondence to Dr. Sterling, Division of Substance Abuse Programs, 1021 S 21st St, 2nd Floor, Philadelphia, PA 19146. Email:ude.nosreffej@gnilrets.treboR

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A More In‐Depth Look at Prescription Opioids

Via:  http://goo.gl/mqlmlj
By:  http://goo.gl/WUevak and http://goo.gl/kjharo

Short-Term Outcomes for Opiate and Crack Users Accessing Treatment: The Effects of Criminal Justice Referral and Crack Use

BACKGROUND/AIMS:

The English drug treatment population doubled in size between 1998 and 2008, increasingly characterised by crack cocaine use and criminal justice system (CJS) referral. We assessed short-term (median 3.5 month) behaviour changes following participation in drug treatment and the moderating effect of CJS referral/crack use.

METHODS:

Opiate and/or crack cocaine users (n = 1,267) were recruited from 342 agencies. Outcome effects were assessed via interaction term regression, clustered at participant level, controlling for client characteristics. Treatment retention effects were tested via Cox proportional hazard models.

RESULTS:

Statistically significant improvements in health, drug use and offensive behaviour were observed (e.g. heroin use from 87 to 51%, acquisitive offending from 47 to 23%). Referral route was not associated with variation in outcomes. Crack use at baseline was associated with a greater chance of non-fatal overdose at follow-up but a greater reduction in offending income (p = 0.002, 95% CI £104-£419).

CONCLUSION:

Despite changes in the English drug treatment population, equivalent short-term improvements in client behaviour were observed a decade earlier. Outcomes for CJS-referred clients were comparable to non-CJS. Crack use at treatment entry offered some scope for greater improvements in offending but may be a barrier to cessation of mortality-associated risky behaviour.

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By:   Jones A1, Hayhurst KP, Millar T, Pierce M, Dunn G, Donmall M.

• 1Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester, UK. 

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The Management of Opiate Use Disorders in France: Results of an Observational Survey of General Practitioners

When opioid-agonist treatments were approved in France in 1995, opiate use disorders began to be managed and treated by general practitioners (GPs), who have since then been encouraged to treat substance use disorders (SUDs) for heroin and other illegal substances. The objective of this study was to describe rates of: 1) SUDs in general practices in France; 2) characteristics of GPs treating SUDs; and 3) clinical practices surrounding SUDs. To place these data in the context of SUD treatment, we also gathered information from practicing SUD specialists.

Between December 2011 and January 2012, a nationally representative sample of GPs and SUD specialists were interviewed by phone, using a 12-item questionnaire that covered number of SUD patients, types of SUDs, and treatments. Data collected were confidential, and analysis was blinded with regard to physician identity.

Forty-four percent of GPs and 68 % of specialists were included in the analysis. The mean number of patients estimated to have been seen at least once in the previous year was 3036 for GPs and 920 for specialists. Ninety-six percent of GPs reported having patients with SUDs. Tobacco, alcohol, and psychoactive drugs were the SUDs most frequently encountered by GPs, whereas tobacco, alcohol, heroin, and cannabis were most frequently encountered by specialists. Forty-three percent of GPs saw at least one patient with a heroin use disorder (HUD), and 82 % of GPs treating patients with HUDs had prescribed an opioid-agonist treatment during the previous 12 months.

The results of this study suggest that a large number of GPs now treat patients with opiate use disorders and that doctors appear to be convinced of the benefits of opioid-agonist therapy and have overcome their initial concerns. This represents a significant change in practice patterns since the introduction of opioid-agonist treatments in France.

Below:  Percent GPs who prescribed opioid-agonist treatment in the previous 12 months

Full article at:  http://goo.gl/rslqxY

By: Pierre Poloméni, Claude Bronner, Fréderic Fry, Bruno Ravoninjatovo, and Mélina Fatseas

Hôpitaux Universitaires Paris Seine St Denis, Site René Muret, Avenue du Dr Schaeffner, Sevran, 93270 France

2 rue de Haslach, 67200 Strasbourg, France

CSAPA Dune, Parvis de la préfecture, Immeuble les Oreades, 95000 Cergy, France

151 Bis rue de Courcelles, 51100 Reims, France

Laboratoire de psychiatrie, Département d’addictologie, Centre hospitalier Charles Perrens, 146 bis, rue Léo Saignat, Bordeaux, 33076 France

Pierre Poloméni, Phone: + 33 (01) 41 52 56 76, Email: rf.phpa.bmr@inemolop.erreip.

Contributor Information.

Corresponding author.

 

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Pain Acceptance & Opiate Use Disorders in Addiction Treatment Patients with Comorbid Pain

Studies from pain treatment settings indicate that poor acceptance of pain may be an important and modifiable risk factor for higher severity of opioid use. However, the degree to which pain acceptance relates to opioid use severity in the addiction treatment population is unknown. In this study of addiction treatment patients with co-morbid pain, we examined correlates of severity of opiate (heroin and prescription opioid) use, with a particular focus on the role of pain acceptance.

Patients in residential addiction treatment with comorbid pain (N = 501) were stratified into low, moderate and high severity of opiate use. Demographic and clinical characteristics were compared across opiate severity categories. 

72% (N = 360) of the participants had symptoms that were consistent with an opiate use disorder. Younger age, Caucasian race, female gender, cocaine use and lower pain acceptance were associated with higher severity of opiate use, whereas pain intensity was not. Controlling for demographic and other risk factors, such as substance use and pain intensity, higher pain acceptance was associated with lower odds of severe prescription opioid and heroin use. 

Problematic opiate use is common in addictions treatment patients with chronic pain. Lower pain acceptance is related to greater opiate use severity, and may be an important modifiable target for interventions to successfully treat both pain and opiate use disorders.

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By: Lewei (Allison) Lin, Amy S.B. Bohnert, Amanda M. Price, Mary Jannausch, Erin E. Bonar, Mark A. Ilgen

University of Michigan, Department of Psychiatry, North Campus Research Complex 2800 Plymouth Road, Ann Arbor, MI 48109

  

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