Get access

Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost-effectiveness analysis

Authors

  • James H. Stephen,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Casey H. Halpern,

    Corresponding author
    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Cristian J. Barrios,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Usha Balmuri,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Jared M. Pisapia,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • John A. Wolf,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Kyle M. Kampman,

    1. Department of Psychiatry, Center for Study of Addiction, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Gordon H. Baltuch,

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Arthur L. Caplan,

    1. Department of Medical Ethics, Center Study of Bioethics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author
  • Sherman C. Stein

    1. Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
    Search for more papers by this author

Casey H. Halpern, Department of Neurosurgery, Centers for Functional and Restorative Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. E-mail: casey.halpern@uphs.upenn.edu

ABSTRACT

Aims  To determine the success threshold at which a theoretical course of deep brain stimulation (DBS) would provide the same quality of life (QoL) and cost-effectiveness for heroin dependence as methadone maintenance treatment (MMT).

Design  We constructed a decision analysis model to calculate QoL after 6 months of MMT and compared it to a theoretical course of DBS. We also performed a cost-effectiveness analysis using societal costs of heroin dependence, MMT and DBS.

Setting  Systematic literature review and meta-analysis

Participants  Patients (n = 1191) from 15 trials administering 6 months of MMT and patients (n = 2937) from 45 trials of DBS for movement disorders.

Measurements  Data on QoL before and after MMT, retention in MMT at 6 months, as well as complications of DBS and their impact on QoL in movement disorders.

Findings  We found a QoL of 0.633 (perfect health = 1) in heroin addicts initiating MMT. Sixty-six per cent of patients completed MMT, but only 47% of them had opiate-free urine samples, resulting in an average QoL of 0.7148 (0.3574 quality-adjusted life years (QALYs) over 6 months). A trial of DBS is less expensive ($81 000) than untreated (or relapsed) heroin dependence ($100 000), but more expensive than MMT ($58 000). A theoretical course of DBS would need a success rate of 36.5% to match MMT, but a success rate of 49% to be cost-effective.

Conclusions  The success rate, defined as the percentage of patients remaining heroin-free after 6 months of treatment, at which deep brain stimulation would be similarly cost-effective in treating opiate addiction to methadone maintenance treatment, is estimated at 49%.

Ancillary