Heroin Dependence
Conditions
Keywords
Economic evaluation, Heroin dependence, Compulsory treatment, Methadone treatment, Vietnam, East and Southeast Asia, Cost-effectiveness
Brief summary
The study 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. The design was a combined retrospective and prospective, non-randomized cohort over three years (with data at five time-points). The study was conducted between 2012 and 2015, involving 208 CCT participants and 384 MMT participants with heroin dependence.
Detailed description
The study 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 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. The five time-points were: baseline, two years after treatment commencement, then three months, six months and 12 months after the initial two years. The study combined primary data and secondary data to assess the effectiveness of the two treatment modalities. The economic component measured the costs of the two treatment modalities to compare cost-effectiveness outcomes. The study had two primary outcomes: self-reported heroin abstinence (confirmed by urine drug screening) and self-reported drug-free days (DFDs). DFDs was reported in two different time-frames. DFDs in the preceding 30 days was used for effectiveness comparison and DFDs over three years was used for the cost-effectiveness comparison. The study has four secondary outcomes: illegal behaviors, overdose, blood-borne virus (BBV) risk behaviors, and monthly drug spending). Mixed effects regression models were used to analyze the effectiveness data and non-parametric bootstrapping methods were used to estimate cost-effectiveness. The time-frame for the cost-effectiveness analysis was three years.
Interventions
OTHERCCT
CCT focuses on behavioral approach, mainly punitive punishment measures.
OTHERMMT
MMT is a combination of pharmaceutical and behavioral intervention.
Sponsors
The Atlantic Philanthropies
FHI 360
Hanoi Medical University
University of Adelaide
The University of New South Wales
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
(for CCT Participants): * 18 years of age and older * Heroin dependent * CCT-released participants who were rehabilitated in the CCT centers under the compulsory track. * CCT-released participants who received the recruitment letter sent by CCT centers' staff and who could provide either the recruitment letter or a certificate of CCT treatment completion at the time of first contact with a researcher as a proof that they were newly CCT-released participants. * Consented voluntarily to participate in the study, as assessed and determined by the researcher providing the informed consent documentation.
Exclusion criteria
(for CCT Participants): * Younger than 18 years old * Severe cognitive or mental impairment * Unable to grant consent for this research study * Non-dependent use of heroin. Inclusion Criteria (for MMT Participants): * 18 years of age and older * Heroin dependence, measured by self-reported daily use of heroin during 3 months prior to index treatment, a proxy to measure heroin dependence * Participated in MMT treatment in Hai Phong City from 2008-2009 * Consented voluntarily to participate in this research, as assessed and determined by the researcher providing the informed consent documentation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Heroin abstinence | Preceding 3 months and 30 days | Free from heroin use (self-reported), confirmed by urine drug screening on interview day. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Drug-free days | Preceding 3 months and 30 days | Days without use of any illicit drugs (self-report) |
| Drug-use related illegal behaviors | Preceding 3 months and 30 days | Drug-use related illegal behaviors |
| Drug-use related blood-borne virus (BBV) risk behaviors | Preceding 3 months and 30 days | Drug-use related blood-borne virus (BBV) risk behaviors |
| Overdose incidents | Preceding 3 months and 30 days | Overdose incidents |
| Monthly drug spending | Preceding 3 months and 30 days | Monthly drug spending |
Countries
Vietnam
Outcome results
None listed