Economic evaluation comparing centre-based compulsory drug rehabilitation with community-based methadone maintenance treatment in Hai Phong City, Vietnam

Date Commenced:
February 2012
Expected Date of Completion:
09/2015
Project Supporters:

NDARC PhD scholarship, Endeavour PhD scholarship, Atlantic Philanthropies through FHI 360 in Vietnam

Drug Type:
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Project Members
image - Marian Shanahan
Conjoint Senior Lecturer
Ph 02 9385 0333
image - Thu
Dr Thu Vuong
Post-Doc Res Fellow (UNSW)
Project Main Description

This study compares the cost-effectiveness of centre-based compulsory rehabilitation (CCT) for substance abuse with community-based methadone maintenance treatment (MMT) in Hai Phong City, Vietnam. The project forms the basis for Thu Vuong's PhD.

Rationale

Currently, in Vietnam, there are two dominant drug dependence treatment approaches. The first one is centre-based compulsory treatment (CCT) which has been implemented for 20 years. If someone in the community is identified as using illicit drugs, they would be encouraged by the community leaders to go through community-based detoxification treatment. If they fail to stop illicit drug use after several treatment attempts, they are to be sent to centre-based compulsory detention for up to 2 years without the benefit of due process or legal safeguard. The services in these centres include education on the dangers of illicit drug use, moral teaching, labour therapy and limited one-size-fits-all vocational training activities. This modality is common in many countries in Southeast Asia. The UN publicly criticises this modality because it violates human rights principles. Currently, about 35% of the total 140,000 registered dependent drug users are kept in these centres. Funding for this modality is solely from the Government.

The other treatment modality is methadone maintenance treatment (MMT), which has been available in Vietnam for 5 years. MMT is voluntary. It provides a legal and safe maintenance opioid for the duration of a person’s life where required. MMT is recommended by WHO/UNAIDS/UNODC as currently the most effective treatment for heroin addiction. Currently, 10% of people who need MMT treatment are in treatment with funding mainly from international donors.

Vietnam became a middle income country in 2010. This means funding from international donors for the existing community-based drug addiction treatment service will decline in the next few years (2014-2018). The Government of Vietnam wants to have evidence of the cost-effectiveness of the two dominant drug dependence treatment approaches in Vietnam for more evidence-informed decision-making in drug treatment and resource allocation.

Aims

To compare the cost-effectiveness of center-based compulsory rehabilitation (CCT) for substance abuse with community-based methadone maintenance treatment (MMT) in Hai Phong City, Vietnam. The key comparison parameters focus on

1) proportion of people free from drug use,

2) number of drug-free days,

3) number of days free from criminal behaviors,

4) number of drug-use related HIV risk behaviors reduced,

5) number of overdose incidents reduced, and

6) number of QALYs gained for heroin users.

Design and Method

The research will follow internationally recognised guidelines for costing substance use treatment interventions and standard economic principles for cost estimations and analysis of cost-effectiveness of the two drug addiction treatment modalities. For this study a societal perspective will be adopted so that all effects of an intervention on cost will be included: patient-incurred costs as well as costs to Government agencies. Societal perspective is the most inclusive perspective in health care economic evaluation. The design and methods for costing and measurement of effectiveness of CCT (Part A) and MMT (Part B) are described below.

Part A (focuses on measuring the costs and effectiveness of CCT):

Primary data on the costs to Government and participants who are placed into the treatment will be collected. To measure the effectiveness of the CCT modality, 220 CCT-released participants will be interviewed about their drug use and drug-related problems at baseline and at 3 and 9 month follow-up interviews.

Primary data will also be collected to measure the effectiveness of CCT. A combined retrospective and prospective longitudinal cohort design will be used. A total of 220 CCT released participants (sample size based on power analysis) will be enrolled as soon as they are released from CCT centres. Interviews will be conducted using a structured questionnaire. Data will be collected to determine drug use behaviours and other related behaviours of the study participants for the 3 months prior to entry into the centres. Follow-up interviews after 3, 6 and 12 months will focus on the same questions. At baseline and follow-up interviews, urine drug screening will also be conducted and compared to participants’ self-report drug use. Although urine drug screening will be performed throughout this study, the use of self-reported data will allow us to measure reductions in illicit opioid use, not abstinence only.

Part B (focuses on measuring the costs and effectiveness of MMT:

Secondary data from two studies (2009 MMT costing study and 2009 MMT cohort study) will be used. In order to ensure a societal perspective to costing, additional data on MMT costing will be collected. These will include opportunity costs of participating in MMT treatment (on 144 MMT patients) and costing of buildings and land for MMT clinics.

Comparing CCT with MMT represents an inquivalence in time horizon because CCT is defined as a two-year rehabilitation process (time-limited) whereas MMT is more than two years and can be a life-time treatment for many people (on-going). In order to minimise this ‘inequivalence in time horizon’, the same time horizon will be framed for both modalities and that time horizon will be 2 years and 12 months to fit with the timeframe of this research.  For CCT, it is the 2 years of rehabilitation plus the 12 months follow-up in the community. For MMT, it is the 2 years of previous cohort study follow-up (secondary data) plus an additional 12 months follow-up (primary data).

Progress/Update

Ethics from UNSW, Hanoi Medical University and FHI360 granted by November 2012

Political endorsement by Hai Phong city Government was granted in February 2012 and regranted in July 2013 (due to change in government leadership)

Data collection was completed by November 2014

Data entry and data analysis started in December 2014

Output

Vuong, T., Ali, R., Baldwin, S., & Mills, S. (2012). Drug policy in Vietnam: A decade of change? International Journal of Drug Policy. 23(4), 319-326.

Project Supporters

NDARC PhD scholarship, Endeavour PhD scholarship, Atlantic Philanthropies through FHI 360 in Vietnam

Project Collaborators: External

Prof Robert Ali
University of Adelaide

Dr Giang Le
Hanoi Medical University

Dr Nhu Nguyen
FHI360 Vietnam

Project Research Area
Drug Type
Project Status
Current
Date Commenced
February 2012

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