AI Article Synopsis

  • The study aimed to establish the success rate of deep brain stimulation (DBS) that would provide similar quality of life (QoL) and cost-effectiveness for heroin dependence compared to methadone maintenance treatment (MMT).
  • A decision analysis model assessed QoL after 6 months of MMT, revealing that 66% of patients completed treatment with only 47% achieving opiate-free status, while examining the costs associated with both treatment methods.
  • Findings indicated that DBS could match MMT's cost-effectiveness if it achieves at least a 49% success rate in keeping patients heroin-free after 6 months.

Article Abstract

Aims: To determine the success threshold at which a theoretical course of deep brain stimulation (DBS) would provide the same quality of life (QoL) and cost-effectiveness for heroin dependence as methadone maintenance treatment (MMT).

Design: We constructed a decision analysis model to calculate QoL after 6 months of MMT and compared it to a theoretical course of DBS. We also performed a cost-effectiveness analysis using societal costs of heroin dependence, MMT and DBS.

Setting: Systematic literature review and meta-analysis.

Participants: Patients (n = 1191) from 15 trials administering 6 months of MMT and patients (n = 2937) from 45 trials of DBS for movement disorders.

Measurements: Data on QoL before and after MMT, retention in MMT at 6 months, as well as complications of DBS and their impact on QoL in movement disorders.

Findings: We found a QoL of 0.633 (perfect health = 1) in heroin addicts initiating MMT. Sixty-six per cent of patients completed MMT, but only 47% of them had opiate-free urine samples, resulting in an average QoL of 0.7148 (0.3574 quality-adjusted life years (QALYs) over 6 months). A trial of DBS is less expensive ($81,000) than untreated (or relapsed) heroin dependence ($100,000), but more expensive than MMT ($58,000). A theoretical course of DBS would need a success rate of 36.5% to match MMT, but a success rate of 49% to be cost-effective.

Conclusions: The success rate, defined as the percentage of patients remaining heroin-free after 6 months of treatment, at which deep brain stimulation would be similarly cost-effective in treating opiate addiction to methadone maintenance treatment, is estimated at 49%.

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Source
http://dx.doi.org/10.1111/j.1360-0443.2011.03656.xDOI Listing

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