تحلیل هزینه–اثربخشی درمان نگهدارنده با متادون و بوپرنورفین به‌منظور پیش‌گیری از بیماری ایدز در معتادان تزریقی (مطالعه موردی: مرکز‌های منتخب ترک اعتیاد تحت نظارت دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شیراز)

نوع مقاله: مقاله پژوهشی

نویسندگان

1 استادیار گروه مدیریت خدمات بهداشتی درمانی دانشگاه آزاد اسلامی شیراز

2 کارشناس ارشد مدیریت خدمات بهداشتی درمانی، گروه مدیریت خدمات بهداشتی و درمانی، دانشگاه آزاد اسلامی واحد علوم و تحقیقات استان فارس

3 استادیار گروه مدیریت خدمات بهداشتی و درمانی دانشگاه آزاد اسلامی مرودشت

چکیده

مقدمه: پژوهش حاضر به تحلیل مقایسه‌ای هزینه-اثربخشی درمان نگهدارنده با داروهای متـادون و بوپرنورفین به‌منظور احتمال پیش‌گیری از انتقال موارد جدید بیماری ایدز در معتادان پرداخته است.
روش پژوهش: پژوهش حاضر مقطعی است و در آن 315 معتاد مراجعه‌کننده به یک مرکز دولتی و یک مرکز خصوصی ارائه‌کننده خدمات درمان نگهدارنده با داروهای متادون و بوپرنورفین تحت نظارت دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شیراز به‌صورت ارزیابی قبل و بعد از مداخله بدون گروه کنترل در طول یک‌ سال بدون نرخ تنزیل مورد بررسی قرار گرفته است. احتمال پیش‌گیری از انتقال بیماری ایدز به‌عنوان واحد اثربخشی با استفاده از درخت تصمیم‌گیری و نرم‌افزار tree age نسخه 2010 برای رفتارهای پرخطر تزریقی و جنسی در قبل و بعد از مراجعه به مرکز محاسبه شده و سپس با استفاده از روش تحلیل حساسیت یک‌طرفه مورد بررسی قرار گرفته است.
یافته‌ها: داروی بوپرنورفین هزینه کم‌تر و اثربخشی بیشتری نسبت به داروی متادون دارد. نسبت هزینه-اثربخشی داروی بوپرنورفین نسبت به داروی متادون معادل 60/861ر307ر705ر17- ریال بدست آمد. هم‌چنین، داروی بوپرنورفین و متادون، به ترتیب، موجب اجتناب از 14 و 47 مورد جدید ابتلا به بیماری ایدز شده است.
نتیجه‌گیری: با توجه به متفاوت بودن نتایج پژوهش باید در مورد استفاده از این دارو‌ها در بُعد منطقه‌ای و ملی احتیاط شده و تصمیم‌گیری در ارتباط با این موضوع نیاز به مطالعه و بحث بیشتری دارد.

کلیدواژه‌ها


عنوان مقاله [English]

The Analysis of Cost-Effectiveness of Methadone and Buprenorphine Maintenance Treatment for Preventing HIV Infection in Drug-Injection Users (A Case Study: The Selected Withdrawal Centers under the Supervision of Shiraz University of Medical Sciences)

نویسندگان [English]

  • S. Hesam 1
  • N. Honarvar 2
  • Sh. Vahdat 3
1 Assistant Professor, Department of Health Care Services Management, Islamic Azad University, Shiraz Branch
2 M. A. in Health Care Services Management, Department of Health Care Services Management, Islamic Azad University of Science and Research of Fars
3 Assistant Professor, Department of Health Care Services Management, Islamic Azad University, Marvdasht Branch
چکیده [English]

Introduction: The present study has carried out a comparative analysis on the cost- effectiveness of maintenance treatment with Methadone and Buprenorphine to prevent the possibility of transmission of new cases from HIV infection among drug users.
Method: This study is cross-sectional, and 315 drug users who referred to a governmental and a private centers that provide services for maintenance treatment with Methadone and Buprenorphine under the supervision of Shiraz University of Medical Sciences have been studied in the form of evaluating after and before intervention without control group during one year and without the discount rate. The possibility of prevention from HIV transmission as a unit of effectivenesshas been calculated by using Decision Tree and Tree Age Software Version 2010 for high risk sexual and drug-injection behaviors before and after referral to the centers, and then it has been investigated via one-way analysis of sensitivity.
Results: Buprenorphine costs less than Methadone, and it has more effectiveness. The cost- effectiveness ratio of Buprenorphine in relation to Methadone was -17,705,307,861.60 Rials. Moreover, Buprenorphine and Methadone have caused the prevention of 14 and 47 new cases from infection with HIV, respectively.
Conclusion: Regarding the distinction between the results of the research, we have to take precautions in using these drugs in the national and regional dimensions, and the decision-making related to this issue requires further study and discussion.

کلیدواژه‌ها [English]

  • Buprenorphine
  • cost
  • effectiveness
  • HIV
  • Methadone
1        UNAIDS, WHO, UNICEF Report (2010). “Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmited Diseases of Islamic Republic of Iran. Gneva: IJNAIDS/UNICEF/WHO”, Updated in 2011, 10, pp. 74-89. Available at: www. UNAIDS.org. [Online][21 August 2013]

2        Mozaffar-zadeh, Sh. and M. Vahdani-nia (2008). “HIV Literacy among Female High School Students”, Payesh Journal, Vol. 7, No. 2 pp. 173-180. [In Persian]

3        WHO (2010). “Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector”, Available at: http://www.unai dsrstesa.org/resources/reports/towards-universal-access-scaling-priority-hi vaids-interventions-health-sector. [Online] [20 July 2013]

4        Vazirian M.; Mohseni, F; and K. Mostashary (2011). The Treatment Protocol of Opioid Dependence with Agonist Drugs. Ministery of Health and Medical Education, Deputy of Health, 2nd Edition, Available at: http://darman.umsu.ac.ir/uploads/meth ad one _protocol.pdf. [Online] [21 August 2013] [In Persian]

5        Hajizadeh, M. (2008). The Economics of Health, 1st Edition, Tehran: Jame-e-negar Publications. [In Persian]

6        Farhadi-nasab, A. and Kh. Mani Kashani (2008). “Investigating the Effect of an Alternative Methadone Treatment with Methadone on Depression Occurred after the Withdrawal of Addicts in Hamadan”, Journal of Ilam University of Medical Sciences, Vol. 16, No. 2, pp. 42-50. [In Persian]

7        Barnett, P. G. (2009). “Comparison of Costs and Utilization among Buprenorphine and Methadone Patients Addiction”, American Journal of Public Health, Vol. 104, No. 6, pp. 982-92.

8        Barnett, P. G. and S. S. Hui (2000). “The Cost-Effectiveness of Methadone Maintenance”, The Mount Sinai Journal of Medicine, Vol. 67, Nos. 5 and 6, pp. 365-74.

9        Gossop, M.; Marsdena, J; Stewarta, D.; and S. Treacy (2002). “Reduced Injection Risk and Sexual Risk Behaviors after Drug Misuse Treatment”, Results from the National Treatment Outcome Research Study, AIDS Care, Vol. 14, pp. 77-93

10    Donighoe, M. C. (1992). “Sex, HIV and Injecting Drug Users”, British Journal of Addiction, Vol. 87, No. 3, pp. 405-16.

11    Rahle, T.; Mills, S.; and R. Maghan (2010). “Evaluating Programs for HIV/AIDS Prevention and Care Developing Countries, a Handbook for Program Managers and Decision Makers”, pp. 219-250, Available at:http://www.fhi.org/NR/rdonlyres/ersim5whcdxjsqzccrfh5yioevtmdgtiidazyyonci2to4awfhxwlop43drijykhieq5lg2nrohlyc/FHI-Frcomplete.pdf. [Online] [05 September 2013]

12    Ahmadnezhad, A.; Karami, Y.; Erfani, R.; Ayyoubian, B.; Hatami, S.; and N. Sepehrvand (2006). “The Study of Beliefs and Behaviors of Girls (11-18 Years of Age) Regarding HIV in Urmia”, Journal of Fundamentals of Mental Health, Vol. 8, Nos. 31 and 32, pp. 81-86. [In Persian]

13    Imamipour, S.; Shams Esfandabad, H.; Sadr-al-sadat, S.; and S. Nezhad Naderi (2008). “The Comparison of Mental Disorders and Quality of Life in Four Groups of Male HIV-Infected Drug Users, Non-Infected Drug Users, Non-Infected and Non-Drug Users”, Journal of  Shahrekord University of Medical Sciences, Vol. 10, No. 1, pp. 69-77. [In Persian]

14    United Nations Office on Drugs and Crime (2006). “Afghanistan Opnium Survey”, Executive Summary, Available at:www.unode.org. [Online] [05 September 2013]

15    Pour-naghash Tehrani, S. (2008). “The Comparision of Efficacy of the Methadone Maintenance Treatment and Detoxification on the Symptoms of Anxiety and Depression in Drug Users”, Journal of Psychological Studies, Vol. 4, No. 2, pp. 81-100. [In Persian]

16    United Nations Office on Drugs and Crime (2013). “Demand Reduction and HIV Control”, Available at: www.unde.org. [Online][05 September 2013]

17    Bayanzadeh, A.; Abualhari, J.; Atef, V.; Nouri Ghasemabadi, R.; Lavasani, F.; and A. Karimi Kismi (2007). “The Role of Medical and Psychological Interventions in Reducing the Risk of Drug Abuse in the Addicted Prisoners”, Razi Journal of Medical Sciences, Vol. 14, No. 55, pp. 47-55. [In Persian]

18    Nabaie, S.; Zamani, A.; Paydar, A. and P. Nabaie (2011). A Guideline on HIV Viewpoints, Ministry of Health and Medical Education, 5th Edition, Tehran: Center of Diseases Management Publications. [In Persian]

19    Mohraz, M. and M. Motamedi Heravi (2003). HIV Diagnosis, Care, and Treatment, 1st Edition, Tehran:Nashre-Seda Publications, Ministry of Health and Medical Education, Center of Diseases Management.  [In Persian]

20    Aref-nasab, Z.; Rahimi, H.; Mohammad, N.; and A. Baba-Mahmoodi (2007). “The Effect of Methadone Maintenance Treatment on the Psychological Health of Opium and Heroin Addicts”, Journal of Developmental Psychology, Vol. 4, No. 13, pp. 43-52.

21    Arab-Zuzani, M.; Bagheri, S.; Najafi, M.; and J. Ebrahimzadeh (2012). The Cost-Effectiveness of Buprenorphine Maintenance Treatment Compared with Methadone Treatment in the Treatment of Opioid Addicts, The 2nd Seminar on Health Economics, Tehran, 26 and 27th January. [In Persian]

22    Masaki, E.; Ravenga, A.; and S. Wang (2007). “Cost-Effectiveness of Tragreted Intervention Guangix”, Available at: http://gametlibrary.Wor ldbank.org. [Online][05 September 2013]

23    Masson, C. L.; Barnett, P. G.; and K. L. Sees (2004). “Cost-Effectiveness of Methadone Maintences as a Health Care Intervention”, Addiction, Vol. 99, pp. 718-726.

24    Rajabi, A. (2013). “Ideal Planning: An Effectiveness Approach to Budgeting and Optimal Allocating of Financial Resources”, Journal of Health Accounting, Vol. 1, Nos. 2 and 3, pp. 1-16. [In Persian]

25    McGowan, R. J.; Brackbill, R. M.; Rugg, D. L.; Swanson, N. M.; Weinsten, B.; Couchon, A.; Scibak, J.; Molde, S.; McLaughlin, P.; Barker, T.; and R. Voigt (1997). “Sex, Drug and HIV Counseling and Testing: Aprospective Study of Behavior-Change among Methadone-Maintenance Clients in New England”, AIDS, Vol. 11, No. 2, pp. 229-235.

26    Lulis, G.; Barnett, P. G. and M. L. Brandeau (2000). “HIV Transmission and the Cost-Effectiveness of Methadone Maintenance”, American Journal of Public Health, Vol. 90, No. 7, pp. 1100-1111.

27    Camacho, L. M.; Bartholomew, N. G.; Joe, G. W.; Cloud, M. A.; and D. D. Simpson (1996). “Gender, Cocaine and During-Treatment HIV Risk Reduction amang Injection Opioid Users in Buprenorphine Maintenance”, Drug and Alcohol Dependence, Vol. 4, No. 1, pp. 1-7.

28    Doran, C. M. (2003). “Buprenorphine, Naloxone and Methadone Maintenance: A Cost-Effectiveness Analysis”, Expert Review of Pharmacoeconomics and Outcomes Research, Vol. 5, No. 5, pp. 583-591.