Economic Evaluation Comparing CCT With MMT in Hai Phong City, Vietnam

The study compared the effectiveness and cost-effectiveness of two dominant heroin dependence treatment approaches: center-based compulsory rehabilitation (CCT) and community-based voluntary methadone treatment (MMT) in Hai Phong City, Vietnam. CCT centers are institutions in which people who use drugs are confined for two years. MMT has been internationally recognized as an efficacious treatment for heroin dependence and was introduced in Vietnam in 2008.

The design was combined retrospective and prospective, non-randomized cohort over three years (with data at five time-points). The study was conducted between 2012 and 2014, involving 208 CCT participants (of which 80% were followed up) and 384 MMT participants (of which 78% were followed up) with heroin dependence. The five time-points were: baseline, two years after treatment commencement, then three months, six months and 12 months after the initial two years. The study combined primary data and secondary data to assess the effectiveness of the two treatment modalities. The economic component measured the costs of the two treatment modalities to compare cost-effectiveness outcomes.

The study had two primary outcomes: self-reported heroin abstinence (confirmed by urine drug screening) and self-reported drug-free days (DFDs). DFDs was reported in two different time-frames. DFDs in the preceding 30 days was used for effectiveness comparison and DFDs over three years was used for the cost-effectiveness comparison. The study has four secondary outcomes: illegal behaviors, overdose, blood-borne virus (BBV) risk behaviors, and monthly drug spending).

Mixed effects regression models were used to analyze the effectiveness data and non-parametric bootstrapping methods were used to estimate cost-effectiveness. The time-frame for the cost-effectiveness analysis was three years.

Inclusion criteria

(for CCT Participants):

• 18 years of age and older
• Heroin dependent
• CCT-released participants who were rehabilitated in the CCT centers under the compulsory track.
• CCT-released participants who received the recruitment letter sent by CCT centers' staff and who could provide either the recruitment letter or a certificate of CCT treatment completion at the time of first contact with a researcher as a proof that they were newly CCT-released participants.
• Consented voluntarily to participate in the study, as assessed and determined by the researcher providing the informed consent documentation.

Exclusion criteria

(for CCT Participants):

• Younger than 18 years old
• Severe cognitive or mental impairment
• Unable to grant consent for this research study
• Non-dependent use of heroin.

Inclusion criteria

(for MMT Participants):

• 18 years of age and older
• Heroin dependence, measured by self-reported daily use of heroin during 3 months prior to index treatment, a proxy to measure heroin dependence
• Participated in MMT treatment in Hai Phong City from 2008-2009
• Consented voluntarily to participate in this research, as assessed and determined by the researcher providing the informed consent documentation.

Exclusion criteria

(for MMT Participants):

• Younger than 18 years old
• Severe cognitive or mental impairment
• Unable to grant consent for this research study
• Non-dependent use of heroin.