Cost of provision of opioid substitution therapy provision in Tijuana, Mexico

Harm Reduction Journal

Raúl Rafael Palacios Lazos¹  Psyché Calderón Vargas²  Steffanie A. Strathdee³  Javier A. Cepeda³  Natasha K. Martin³  Maria Luisa Mittal³  Jose Luis Burgos³  James G. Kahn⁴  Peter Vickerman⁵  Emilio Meza⁶ 

[1] Centro de Integracion Juvenil;Centro de la Conducta;Division of Infectious Disease and Global Public Health, Department of Medicine, University of California;Institute for Health Policy Studies, School of Medicine, University of California;School of Social and Community Medicine, University of Bristol;State Government of Oaxaca;

关键词: Opioid substitution therapy;    Methadone;    Mexico;    Cost;   

DOI  :  10.1186/s12954-018-0234-x

来源: DOAJ

【 摘 要 】

Abstract Background Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. Methods We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined “delivery cost” as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. Results The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93–$2.66 per methadone dose. Conclusions The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.

【 授权许可】

Unknown