Economic evaluation comparing the cost-effectiveness of center-based compulsory rehabilitation (CCT) and voluntary community-based methadone maintenance treatment (MMT) in Hai Phong City, Vietnam.

Abstract

The study in this dissertation compared the effectiveness and cost-effectiveness of two dominant heroin dependence treatment approaches: center-based compulsory rehabilitation (CCT) and community-based voluntary methadone treatment (MMT) in Hai Phong City, Vietnam. CCT centers are institutions in which people who use drugs are confined for two years. MMT has been internationally recognized as an efficacious treatment for heroin dependence and was introduced in Vietnam in 2008.

The design was a pragmatic, combined retrospective and prospective, non-randomized cohort over three years (with data at five time-points). The study was conducted between 2012 and 2014, involving 208 CCT participants (of which 80% were followed up) and 384 MMT participants (of which 78% were followed up) with heroin dependence. Mixed effects regression models were used to analyze the effectiveness data and non-parametric bootstrapping methods were used to estimate cost-effectiveness.

The study found greater effectiveness of MMT treatment for four outcome measures (‘heroin use’ (β=4.03, SE=0.16, p<.0001), ‘drug-free days (in the preceding 30 days)’ (β=17.51, SE=0.49, p<.0001), ‘BBV risk behaviors’ (β=0.41, SE=0.09, p<.0001), equivalent to OR=1.51, and ‘monthly drug spending’ (β=-4,863,100, SE=262,400, p<.0001)). The analyses did not support the hypothesis that MMT was associated with greater effectiveness pertaining to two outcome variables ‘illegal behaviors’ (β=0.19, SE=0.11, p=0.09) and ‘overdose’ (β=0.03, SE=0.21, p=0.62). Over three years, MMT cost on average VND85.73 million less than CCT (95% CI: -VND76.88 million, -VND94.59 million). On average, a MMT participant had 344.20 more drug-free days compared to a CCT participant and the difference was statistically significant (p<0.001). The results suggested that MMT dominated CCT (both less expensive and more effective).

The study findings have been and will continue to be used for drug policy advocacy in Vietnam. Scientific evidence is only one type of information available to politicians. Information, including scientific and other types of information, has to compete with ideologies and self-interests to gain primacy in policy making. Evidence can make a difference, particularly in countries that take pragmatic approaches to health problems like Vietnam.