Cost-effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: Dynamic modeling analysis
BACKGROUND AND AIMS: Although opioid agonist treatment (OAT) for opioid use disorder (OUD) is cost-effective in settings where the HIV epidemic is concentrated among people who inject drugs, OAT coverage in Ukraine remains far below internationally-recommended targets. Scale-up is limited by both OAT availability and demand. This study aimed to evaluate the cost-effectiveness of a range of plausible OAT scale-up strategies in Ukraine incorporating the potential impact of treatment spillover and the real-world demand for addiction treatment. DESIGN: 10-year horizon (2016-2025) modelling study of opioid addiction epidemic and treatment that accommodated potential peer effects in opioid use initiation and supply-induced treatment demand.
SETTING: Three Ukrainian cities: Kyiv, Mykolaiv and Lviv. PARTICIPANTS: Simulated population of people at risk of and with OUD.
MEASUREMENTS: Incremental cost per quality-adjusted life year gained in the simulated population.
FINDINGS: An estimated 12.2-fold, 2.4-fold, and 13.4-fold OAT capacity increase over 2016 baseline capacity in Kyiv, Mykolaiv, and Lviv, respectively, would be cost-effective at a willingness-to-pay of one per capita GDP per quality-adjusted life-year gained. This result is robust to parametric and structural uncertainty. Even under the most ambitious capacity increase, OAT coverage (i.e., the proportion of persons with OUD receiving OAT) over a 10-year modeling horizon would be 20%, 11%, and 17% in Kyiv, Mykolaiv, and Lviv, respectively, owing to limited demand.
CONCLUSIONS: It is estimated that a substantial increase in opioid agonist treatment (OAT) capacity in three Ukrainian cities would be cost-effective for a wide range of willingness-to-pay thresholds. Even a very ambitious capacity increase, however, is unlikely to reach internationally-recommended coverage levels. Further increases in coverage may be limited by demand and would require addressing existing structural barriers to OAT access.
Morozova, O., Crawford, F. W., Cohen, T., Paltiel, A. D., & Altice, F. L. (2019). Cost-effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: Dynamic modeling analysis. Addiction. doi:10.1111/add.14797