Study On The Effect And Economic Evaluation Of Community Methadone Maintenance Treatment For Patients With Heroin Dependence

Part one study on the retention rate and effect of methadone maintenance treatment (MMT) for patients with heroin dependence in Hunan provinceObjective:( 1 ) To explore the retention rate and influence factors of methadone maintenance treatment (MMT) in Hunan province. (2) To explore the changes of risk behaviors, function of family and society and crime rate before and after treatment. (3) To explore the changes of degree of craving for heroin and quality of life (QOL) and influence factors before and after treatment.Methods:To apply the cohort analysis to follow up the MMT patients for 1 year. "community MMT baseline questionnaire"," community MMT follow-up questionnaire", "craving for heroin questionnaire ","quality of life brief " were used to collect the information before and after6 months treatment respectively. The treatment information of MMT clinic patients were collected and analyze.Results:(1) The dose of methadone is higher among HIV positive patients and injecting drug users. (2) The retention rate is 72.06% and 49.65% in 6 months and 1year respectively in Hunan province. The retention time is longer among patients with Higher dose, older, and HIV positive.(3) The rate of patients obtaining jobs increased 9.13%; the rate of good relationship among families increased 13.6%; and the frequency of contact among drug users decreased. (4) The frequency of injecting drug declined from 95.94% to 26.17% after treatment. The frequency of sharing needle and equipment and the numbers of sharing with decreased significantly. (5 ) The rate of crime decline from 22.3% to 9.5%. (6) the score of each factor and total scores of heroin craving were lower and the scores of QOL were higher after treatment, especially for male and patients with longer drug use.Conclusion:(1) MMT can reduce the risk behaviours among drug users,improve the function of family and society, and decrease the crime rate.(2) MMT can decrease the degree of craving for heroin and behavioursof hunting for drug and drug taking. (3) MMT can improve the patients'quality of life. Part Two economic evaluation of community methadone maintenance treatment (MMT) for patients with heroin dependenceObjective:To explore the cost, cost-effectiveness, cost-utility and cost-benefit of 7 methadone maintenance treatment clinics in Hunan province.Methods:Using the IDU2.4 model to evaluate the number of HIV averted after MMT treatment, according to the information of investigation and literature. The expense for intervention in 7 MMT clinics as the cost index and the number of averted infection, QALYs and benefit obtained after intervention as the effectiveness index were used to analyze the economic efficacy.Results:According to IDU2.4 model, 286 HIV positive persons were averted after intervention of 7 MMT clinics for lyear in our province. The cost of averted 1 HIV infection is 5880.84Yuan (RMB) . The cost of obtaining 1 QALYs is 330.38Yuan (RMB) , and the benefit-cost ratio is 88.99.Conclusion:(1) IDU2.4 model is a simple, suitable, correct model to estimate the effectiveness of harm reduction project. (2) The 7 MMT clinics in our province have good economic efficacy.