Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis
Autoři:
Cora L. Bernard aff001; Isabelle J. Rao aff001; Konner K. Robison aff001; Margaret L. Brandeau aff001
Působiště autorů:
Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America
aff001
Vyšlo v časopise:
Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis. PLoS Med 17(10): e32767. doi:10.1371/journal.pmed.1003239
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003239
Souhrn
Background
Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders.
Methods and findings
We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size.
Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%–4.0%) and 3.3% (95% CI 3.1%–3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%–10.8%), and jail population size by 6.3% (95% CI 5.9%–6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600–$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost.
A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure.
Conclusions
We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).
Klíčová slova:
Criminal justice system – Drug therapy – Hepatitis C virus – HIV – HIV epidemiology – HIV infections – Medical risk factors – Prisons
Zdroje
1. United Nations AIDS Programme (UNAIDS). UNAIDS urges countries to adopt a people-, rights- and health-centred approach to reverse the HIV epidemic among people who inject drugs Geneva, Switzerland: UNAIDS; 15 April 2016. [cited 2019 Sep 10]. Available from: http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/april/20160415_UNGASS
2. Minton TD, Zeng Z. Jail Inmates in 2015: US Department of Justice Office of Justice Programs, Bureau of Justice Statistics; 2016 [cited 2019 Jun 5]. Available from: https://www.bjs.gov/content/pub/pdf/ji15.pdf
3. Freudenberg N. Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health. J Urban Health. 2001;78(2):214–35. doi: 10.1093/jurban/78.2.214 11419576
4. Marks JS, Turner N. The critical link between health care and jails. Health Affairs (Millwood). 2014;33(3):443–7.
5. Stephenson BL, Wohl DA, Golin CE, Tien HC, Stewart P, Kaplan AH. Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals. Public Health Rep. 2005;120(1):84–8. doi: 10.1177/003335490512000114 15736336
6. Baillargeon J, Giordano TP, Rich JD, Wu ZH, Wells K, Pollock BH, et al. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–57. doi: 10.1001/jama.2009.202 19244192
7. Huh K, Boucher A, McGaffey F, McKillop M, Schiff M. Jails: Inadvertent Health Care Providers. The Pew Charitable Trusts, 2018.
8. Larney S, Gisev N, Farrell M, Dobbins T, Burns L, Gibson A, et al. Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study. BMJ Open. 2014;4(4):e004666. doi: 10.1136/bmjopen-2013-004666 24694626
9. Maryland Department of Health and Mental Hygiene. Risk of overdose death following release from prison or jail 2014. [cited 2018 Jun 29]. Available from: https://bha.health.maryland.gov/OVERDOSE_PREVENTION/Documents/corrections%20brief_V3.pdf
10. Rich JD, McKenzie M, Larney S, Wong JB, Tran L, Clarke J, et al. Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial. Lancet. 2015;386(9991):350–9. doi: 10.1016/S0140-6736(14)62338-2 26028120
11. Degenhardt L, Larney S, Kimber J, Gisev N, Farrell M, Dobbins T, et al. The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction. 2014;109(8):1306–17. doi: 10.1111/add.12536 24612249
12. Aleccia J. Heroin deaths drop in King County, but addiction still a serious problem. Seattle Times. 2016 July 19.
13. Anglin MD, Nosyk B, Jaffe A, Urada D, Evans E. Offender diversion into substance use disorder treatment: the economic impact of California's proposition 36. Am J Public Health. 2013;103(6):1096–102. doi: 10.2105/AJPH.2012.301168 23597352
14. Fielding JE, Tye G, Ogawa PL, Imam IJ, Long AM. Los Angeles County drug court programs: initial results. J Subst Abuse Treat. 2002;23(3):217–24. doi: 10.1016/s0740-5472(02)00262-3 12392808
15. Shannon LM, Jackson Jones A, Newell J, Neal C. Examining the impact of prior criminal justice history on 2-year recidivism rates: a comparison of drug court participants and program referrals. Int J Offender Ther Comp Criminol. 2018;62(2):291–312. doi: 10.1177/0306624X16645323 27125834
16. Dugosh KL, Festinger DS, Lipkin JL. Identifying and addressing the unmet health care needs of drug court clients. J Subst Abuse Treat. 2016;71:30–5. doi: 10.1016/j.jsat.2016.08.017 27776674
17. Clifasefi SL, Collins SE. LEAD Program Evaluation: Describing LEAD Case Management in Participants’ Own Words: Harm Reduction Research and Treatment Lab at the University of Washington Harborview Medical Center; 2016. [cited 2020 Sep 26]. Available from: http://static1.1.sqspcdn.com/static/f/1185392/27320150/1478294794537/Specific-Aim-4-FINAL_UW-LEAD-Evaluation-Qualitative-Report-11.1.16_updated.pdf?token=2KYfgiARMcbKz33DPDz24fjXysQ%3D.
18. Clifasefi SL, Lonczak HS, Collins SE. LEAD Program Evaluation: The Impact of LEAD on Housing, Employment and Income/Benefits: Harm Reduction Research and Treatment Lab at the University of Washington Harborview Medical Center; 2016.
19. LEAD: Law Enforcement Assisted Diversion. About LEAD 2018. [cited 2018 Jun 29]. Available from: http://leadkingcounty.org/about/.
20. Collins SE, Lonczak HS, Clifasefi SL. LEAD Program Evaluation: Criminal Justice and Legal System Utilization and Associated Costs: Harm Reduction Research and Treatment Lab at the University of Washington Harborview Medical Center; 2015.
21. Collins SE, Lonczak HS, Clifasefi SL. LEAD Program Evaluation: Recidivism Report: Harm Reduction Research and Treatment Lab at the University of Washington Harborview Medical Center; 2015 [cited 2020 Sep 26]. Available from: http://static1.1.sqspcdn.com/static/f/1185392/26121870/1428513375150/LEAD_EVALUATION_4-7-15.pdf
22. Collins SE, Lonczak HS, Clifasefi SL. Seattle's Law Enforcement Assisted Diversion (LEAD): program effects on recidivism outcomes. Eval Program Plann. 2017;64:49–56. doi: 10.1016/j.evalprogplan.2017.05.008 28531654
23. Kingston S, Banta-Green C. Results from the 2015 Washington State Drug Injector Health Survey Seattle, Washington: University of Washington; 2016. [updated Feb 2016; cited 2018 Jun 29]. Available from: http://adai.uw.edu/pubs/infobriefs/2015DrugInjectorHealthSurvey.pdf
24. Buskin S, Hanrahan M, Jaenicke T. HIV/AIDS epidemiology report 2015 (volume 84) Seattle, WA: HIV/AIDS Epidemiology Unit, Public Health–Seattle & King County and the Infectious Disease Assessment Unit, Washington State Department of Health; 2016. [cited 2019 Jun 7]. Available from: http://www.kingcounty.gov/healthservices/health/communicable/hiv/epi/~/media/health/publichealth/documents/hiv/2015EpiReport.ashx
25. Vance-Sherman A. King County profile Olympia, WA: Washington State Employment Security Department; 2015 [cited 2018 Jun 1]. Available from: https://fortress.wa.gov/esd/employmentdata/reports-publications/regional-reports/county-profiles/king-county-profile
26. Seattle and King County Public Health Department. Facts about HIV/AIDS in incarcerated people 2009 [cited 2018 Jun 15]. Available from: http://www.kingcounty.gov/healthservices/health/communicable/hiv/epi/~/media/health/publichealth/documents/hiv/HIVIncarcerated.ashx
27. Monteiro JF, Escudero DJ, Weinreb C, Flanigan T, Galea S, Friedman SR, et al. Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs. Epidemiol Infect. 2016;144(8):1683–700. doi: 10.1017/S0950268815003180 26753627
28. University of Washington. Hepatitis C online 2017. [cited 2018 Apr 3]. Available from: http://www.hepatitisc.uw.edu/.
29. Valdiserri RO, Koh HK. Breaking the silence on viral hepatitis. Ann Intern Med. 2014;161(2):147–8. doi: 10.7326/M14-0404 24781348
30. Buskin S, Hanrahan M, Jaenicke T. HIV/AIDS epidemiology report, first half 2013 (volume 82) Seattle, WA: HIV/AIDS Epidemiology Unit, Public Health–Seattle & King County and the Infectious Disease Assessment Unit, Washington State Department of Health; 2013. [cited 2019 Jun 7]. Available from: http://www.kingcounty.gov/healthservices/health/communicable/hiv/epi/~/media/health/publichealth/documents/hiv/1stHalf2013EpiReport.ashx
31. Berk Consulting. Analysis of Statewide Adult Correctional Needs and Costs. Final Report Submitted to the Office of Financial Management, November 6, 2014. Washington State. 2014 [cited 2018 Jun 29]. Available from: http://www.ofm.wa.gov/reports/Correctional_Needs_and_Costs_Study2014.pdf
32. Washington State Office of Financial Management. Prison inmate population Seattle, Washington: The State of Washington; 2017 [updated January 9, 2017; cited 2018 Jun 29]. Available from: http://www.ofm.wa.gov/trends/budget/fig408.asp
33. The National Center on Addiction and Substance Abuse at Columbia University. Behind Bars II: Substance Abuse and America’s Prison Population. New York: Columbia University, 2010.
34. Washington State Department of Corrections. Average daily population of incarcerated individuals, fiscal year 2017 2017 [cited 2020 Sep 26]. Available from: https://www.doc.wa.gov/docs/publications/reports/400-RE002-1906.pdf
35. Washington State Department of Corrections. Washington State prisons. March 2016. 2016 [cited 2020 Sep 26]. Available from: https://doc.wa.gov/corrections/incarceration/prisons/default.htm/.
36. Washington State Department of Corrections. Number of prison admissions by county of admission. August 2015. 2015 [cited 2020 Sep 26]. Available from: https://www.doc.wa.gov/docs/publications/reports/200-RE001.pdf
37. King County Department of Adult and Juvenile Detention. Detention and alternatives report 2015 [cited 2018 Jun 29]. Available from: http://www.kingcounty.gov/~/media/courts/detention/documents/KC_DAR_12_2015.ashx?la=en
38. Hamilton DT, Handcock MS, Morris M. Degree distributions in sexual networks: a framework for evaluating evidence. Sex Transm Dis. 2008;35(1):30–40. doi: 10.1097/olq.0b013e3181453a84 18217224
39. Bendavid E, Brandeau ML, Wood R, Owens DK. Comparative effectiveness of HIV testing and treatment in highly endemic regions. Arch Intern Med. 2010;170(15):1347–54. doi: 10.1001/archinternmed.2010.249 20696960
40. Public Health Agency of Canada. HIV transmission risk: A summary of the evidence 2012 [cited 2018 Jun 29]. Available from: http://www.catie.ca/sites/default/files/HIV-TRANSMISSION-RISK-EN.pdf
41. Larney S, Toson B, Burns L, Dolan K. Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration. Addiction. 2012;107(2):372–80. doi: 10.1111/j.1360-0443.2011.03618.x 21851442
42. Bernard CL, Brandeau ML, Owens DK, Humphreys K, Bendavid E, Weyant C, et al. Cost-effectiveness of HIV preexposure prophylaxis for people who inject drugs in the United States. Ann Intern Med. 2016;165(1):10–9. doi: 10.7326/M15-2634 27110953
43. Chun J, Guydish JR, Silber E, Gleghorn A. Drug treatment outcomes for persons on waiting lists. Am J Drug Alcohol Abuse. 2008;34(5):526–33. doi: 10.1080/00952990802146340 18618338
44. Redko C, Rapp RC, Carlson RG. Waiting time as a barrier to treatment entry: perceptions of substance users. J Drug Issues. 2006;36(4):831–52. doi: 10.1177/002204260603600404 18509514
45. Bernard CL, Owens DK, Goldhaber-Fiebert JD, Brandeau ML. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: a model-based analysis. PLoS Med. 2017;14(5):e1002312. doi: 10.1371/journal.pmed.1002312 28542184
46. van Ameijden EJ, van den Hoek JA, Hartgers C, Coutinho RA. Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users. Am J Epidemiol. 1994;139(12):1153–63. doi: 10.1093/oxfordjournals.aje.a116962 8209874
47. Fuller CM, Vlahov D, Ompad DC, Shah N, Arria A, Strathdee SA. High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study. Drug Alcohol Depend. 2002;66(2):189–98. doi: 10.1016/s0376-8716(01)00200-9 11906806
48. Arias E. United States life tables, 2010. Natl Vital Stat Rep. 2014;63(7):1–63. 25383611
49. Liu S, Cipriano LE, Holodniy M, Owens DK, Goldhaber-Fiebert JD. New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis. Ann Intern Med. 2012;156(4):279–90. doi: 10.7326/0003-4819-156-4-201202210-00005 22351713
50. Bendavid E, Young SD, Katzenstein DA, Bayoumi AM, Sanders GD, Owens DK. Cost-effectiveness of HIV monitoring strategies in resource-limited settings–a Southern African analysis. Arch Intern Med. 2008;168(17):1910–8. doi: 10.1001/archinternmed.2008.1 18809819
51. Zhong H, Arjmand IK, Brandeau ML, Bendavid E. Clinical outcomes and cost-effectiveness of treating depression in HIV-infected populations in sub-Saharan Africa: a model-based analysis. AIDS Care. 2020; Jan 20:1–7, Epub ahead of print.
52. National Institute on Drug Abuse. Overdose death rates, revised 2017 2017 [cited 2018 Jun 29]. Available from: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
53. Bird SM, Parmar MK, Strang J. Take-home naloxone to prevent fatalities from opiate-overdose: protocol for Scotland's public health policy evaluation, and a new measure to assess impact. Drugs (Abingdon Engl). 2015;22(1):66–76.
54. Lee JD, McDonald R, Grossman E, McNeely J, Laska E, Rotrosen J, et al. Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial. Addiction. 2015;110(6):1008–14. doi: 10.1111/add.12894 25703440
55. Stevens JP, Wall MJ, Novack L, Marshall J, Hsu DJ, Howell MD. The critical care crisis of opioid overdoses in the United States. Ann Am Thorac Soc. 2017;14(12):1803–9. doi: 10.1513/AnnalsATS.201701-022OC 28800256
56. Darke S, Mattick RP, Degenhardt L. The ratio of non-fatal to fatal heroin overdose. Addiction. 2003;98(8):1169–71.
57. Drake EK, Aos S, Miller MG. Evidence-based public policy options to reduce crime and criminal justice costs: implications in Washington State. Victims & Offenders. 2009;4(2):170–96.
58. Weinstein MC, O'Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al. Principles of good practice for decision analytic modeling in health-care evaluation: Report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health. 2003;6(1):9–17. doi: 10.1046/j.1524-4733.2003.00234.x 12535234
59. Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016;316(10):1093–103. doi: 10.1001/jama.2016.12195 27623463
60. Marshall BDL, Wood E. Towards a comprehensive approach to HIV prevention for people who use drugs. J Acquir Immune Defic Syndr. 2010;55 Suppl 1:S23–S6.
61. Cipriano LE, Zaric GS, Holodniy M, Bendavid E, Owens DK, Brandeau ML. Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users. PLoS ONE. 2012;7(9):e45176. doi: 10.1371/journal.pone.0045176 23028828
62. Caro JJ, Briggs AH, Siebert U, Kuntz KM. Modeling good research practices—overview: A report of the ISPOR-SMDM Modeling Good Research Practices Task Force—1. Value Health. 2012;15(6):796–803. doi: 10.1016/j.jval.2012.06.012 22999128
63. Bernard CL, Brandeau ML. Structural sensitivity in HIV modeling: a case study of vaccination. Infect Dis Model. 2017;2(4):399–411. doi: 10.1016/j.idm.2017.08.002 29532039
64. Scott N, Hellard M, McBryde ES. Modeling hepatitis C virus transmission among people who inject drugs: assumptions, limitations and future challenges. Virulence. 2016;7(2):201–8. doi: 10.1080/21505594.2015.1085151 26305706
Článek vyšel v časopise
PLOS Medicine
2020 Číslo 10
- S diagnostikou Parkinsonovy nemoci může nově pomoci AI nástroj pro hodnocení mrkacího reflexu
- Proč při poslechu některé muziky prostě musíme tančit?
- Chůze do schodů pomáhá prodloužit život a vyhnout se srdečním chorobám
- „Jednohubky“ z klinického výzkumu – 2024/44
- Je libo čepici místo mozkového implantátu?
Nejčtenější v tomto čísle
- Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis
- Correction: Social distancing to slow the US COVID-19 epidemic: Longitudinal pretest–posttest comparison group study
- The impact of continuous quality improvement on coverage of antenatal HIV care tests in rural South Africa: Results of a stepped-wedge cluster-randomised controlled implementation trial
- Variation in racial/ethnic disparities in COVID-19 mortality by age in the United States: A cross-sectional study
