The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users: A Modeling Study

Mehdi Javanbakht, Alireza Mirahmadizadeh, Atefeh Mashayekhi*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background: Chronic infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Illicit injection drug use is an important risk factor for the rising hepatitis C virus (HCV) prevalence in IR Iran.

Objectives: The objective of this study was to determine the long-term effectiveness (total quality adjusted life years (QALYs) gained) of methadone maintenance treatment (MMT program) in prevention of HCV infection among injecting drug users (IDUs).

Materials and Methods: A number of Markov models were developed to model morbidity and mortality among IDUs. The input data used in modeling were collected by a self-reported method from 259 IDUs before registration and one year after MMT and also from previous studies. One way and probabilistic sensitivity analyses were done to show the effects of uncertainty in parameters on number of life years and QALYs saved. The expected consequences were estimated using a life-time time horizon for the two strategies including implementation and not implementation of the MMT program.

Results: Our model estimated that total number of discounted life years lived per IDU with and without the MMT program would be 5.15 (5.05- 5.25) and 4.63 (4.42- 4.81),respectively. The model also estimated that total number of discounted QALYs lived per IDU with and without the MMT program would be 4.11 (3.86-4.41) and 2.45 (2.17 - 2.84). Simulation results indicated that all differences in life years and QALYs lived between the two strategies were statistically significant (p <0.001). Based on our model, total discounted life years and QALYs saved in a cohort of 1000 IDUs were 1790 (1520 - 2090) and 1590 (1090-2090), respectively.

Conclusions: Considering the high prevalence of illicit injecting drug use in Iran and MMT effectiveness in prevention of HCV infection, it is necessary to develop MMT centers at regional and national levels.

Original languageEnglish
Article number13484
Number of pages9
JournalIranian red crescent medical journal
Volume16
Issue number2
Early online date7 Feb 2014
DOIs
Publication statusPublished - Feb 2014

Keywords

  • Hepatitis C Virus
  • Iran
  • methadone maintenance treatment
  • quality adjusted life years
  • illicit drug users
  • Markov Model
  • human-immunodeficiency-virus
  • cost-effectiveness
  • sexual transmission
  • prospective cohort
  • inject drugs
  • risk-factors
  • infection
  • prevalence
  • impact
  • metaanalysis

Cite this

The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users : A Modeling Study. / Javanbakht, Mehdi; Mirahmadizadeh, Alireza; Mashayekhi, Atefeh.

In: Iranian red crescent medical journal, Vol. 16, No. 2, 13484, 02.2014.

Research output: Contribution to journalArticle

@article{db9a8ec8750b4b5d85972c7f83e0df31,
title = "The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users: A Modeling Study",
abstract = "Background: Chronic infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Illicit injection drug use is an important risk factor for the rising hepatitis C virus (HCV) prevalence in IR Iran.Objectives: The objective of this study was to determine the long-term effectiveness (total quality adjusted life years (QALYs) gained) of methadone maintenance treatment (MMT program) in prevention of HCV infection among injecting drug users (IDUs).Materials and Methods: A number of Markov models were developed to model morbidity and mortality among IDUs. The input data used in modeling were collected by a self-reported method from 259 IDUs before registration and one year after MMT and also from previous studies. One way and probabilistic sensitivity analyses were done to show the effects of uncertainty in parameters on number of life years and QALYs saved. The expected consequences were estimated using a life-time time horizon for the two strategies including implementation and not implementation of the MMT program.Results: Our model estimated that total number of discounted life years lived per IDU with and without the MMT program would be 5.15 (5.05- 5.25) and 4.63 (4.42- 4.81),respectively. The model also estimated that total number of discounted QALYs lived per IDU with and without the MMT program would be 4.11 (3.86-4.41) and 2.45 (2.17 - 2.84). Simulation results indicated that all differences in life years and QALYs lived between the two strategies were statistically significant (p <0.001). Based on our model, total discounted life years and QALYs saved in a cohort of 1000 IDUs were 1790 (1520 - 2090) and 1590 (1090-2090), respectively.Conclusions: Considering the high prevalence of illicit injecting drug use in Iran and MMT effectiveness in prevention of HCV infection, it is necessary to develop MMT centers at regional and national levels.",
keywords = "Hepatitis C Virus, Iran, methadone maintenance treatment, quality adjusted life years, illicit drug users, Markov Model, human-immunodeficiency-virus, cost-effectiveness, sexual transmission, prospective cohort, inject drugs, risk-factors, infection, prevalence, impact, metaanalysis",
author = "Mehdi Javanbakht and Alireza Mirahmadizadeh and Atefeh Mashayekhi",
note = "Article Accepted Date: Oct 7, 2013 Acknowledgments: We would like to thank all MMT centers' staff in Shiraz for their cooperation in this study. Funding Support: This study was funded and supported by the Tehran University of Medical Sciences.",
year = "2014",
month = "2",
doi = "10.5812/ircmj.13484",
language = "English",
volume = "16",
journal = "Iranian red crescent medical journal",
issn = "2074-1804",
publisher = "Kowsar Publishing Company",
number = "2",

}

TY - JOUR

T1 - The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users

T2 - A Modeling Study

AU - Javanbakht, Mehdi

AU - Mirahmadizadeh, Alireza

AU - Mashayekhi, Atefeh

N1 - Article Accepted Date: Oct 7, 2013 Acknowledgments: We would like to thank all MMT centers' staff in Shiraz for their cooperation in this study. Funding Support: This study was funded and supported by the Tehran University of Medical Sciences.

PY - 2014/2

Y1 - 2014/2

N2 - Background: Chronic infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Illicit injection drug use is an important risk factor for the rising hepatitis C virus (HCV) prevalence in IR Iran.Objectives: The objective of this study was to determine the long-term effectiveness (total quality adjusted life years (QALYs) gained) of methadone maintenance treatment (MMT program) in prevention of HCV infection among injecting drug users (IDUs).Materials and Methods: A number of Markov models were developed to model morbidity and mortality among IDUs. The input data used in modeling were collected by a self-reported method from 259 IDUs before registration and one year after MMT and also from previous studies. One way and probabilistic sensitivity analyses were done to show the effects of uncertainty in parameters on number of life years and QALYs saved. The expected consequences were estimated using a life-time time horizon for the two strategies including implementation and not implementation of the MMT program.Results: Our model estimated that total number of discounted life years lived per IDU with and without the MMT program would be 5.15 (5.05- 5.25) and 4.63 (4.42- 4.81),respectively. The model also estimated that total number of discounted QALYs lived per IDU with and without the MMT program would be 4.11 (3.86-4.41) and 2.45 (2.17 - 2.84). Simulation results indicated that all differences in life years and QALYs lived between the two strategies were statistically significant (p <0.001). Based on our model, total discounted life years and QALYs saved in a cohort of 1000 IDUs were 1790 (1520 - 2090) and 1590 (1090-2090), respectively.Conclusions: Considering the high prevalence of illicit injecting drug use in Iran and MMT effectiveness in prevention of HCV infection, it is necessary to develop MMT centers at regional and national levels.

AB - Background: Chronic infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Illicit injection drug use is an important risk factor for the rising hepatitis C virus (HCV) prevalence in IR Iran.Objectives: The objective of this study was to determine the long-term effectiveness (total quality adjusted life years (QALYs) gained) of methadone maintenance treatment (MMT program) in prevention of HCV infection among injecting drug users (IDUs).Materials and Methods: A number of Markov models were developed to model morbidity and mortality among IDUs. The input data used in modeling were collected by a self-reported method from 259 IDUs before registration and one year after MMT and also from previous studies. One way and probabilistic sensitivity analyses were done to show the effects of uncertainty in parameters on number of life years and QALYs saved. The expected consequences were estimated using a life-time time horizon for the two strategies including implementation and not implementation of the MMT program.Results: Our model estimated that total number of discounted life years lived per IDU with and without the MMT program would be 5.15 (5.05- 5.25) and 4.63 (4.42- 4.81),respectively. The model also estimated that total number of discounted QALYs lived per IDU with and without the MMT program would be 4.11 (3.86-4.41) and 2.45 (2.17 - 2.84). Simulation results indicated that all differences in life years and QALYs lived between the two strategies were statistically significant (p <0.001). Based on our model, total discounted life years and QALYs saved in a cohort of 1000 IDUs were 1790 (1520 - 2090) and 1590 (1090-2090), respectively.Conclusions: Considering the high prevalence of illicit injecting drug use in Iran and MMT effectiveness in prevention of HCV infection, it is necessary to develop MMT centers at regional and national levels.

KW - Hepatitis C Virus

KW - Iran

KW - methadone maintenance treatment

KW - quality adjusted life years

KW - illicit drug users

KW - Markov Model

KW - human-immunodeficiency-virus

KW - cost-effectiveness

KW - sexual transmission

KW - prospective cohort

KW - inject drugs

KW - risk-factors

KW - infection

KW - prevalence

KW - impact

KW - metaanalysis

U2 - 10.5812/ircmj.13484

DO - 10.5812/ircmj.13484

M3 - Article

VL - 16

JO - Iranian red crescent medical journal

JF - Iranian red crescent medical journal

SN - 2074-1804

IS - 2

M1 - 13484

ER -