The Cost of Providing Methadone Maintenance Treatment in Ontario, Canada

Abstract

Objectives: To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer. Methods: We analyzed a database of all patient clinic visits, laboratory tests for urine toxicology screening, and methadone scripts from a group of methadone clinics in Ontario. The database consisted of patient visits and visit information from 1 January 2003 to 31 December 2009. We estimated the cost of providing methadone maintenance treatment as the sum of physician costs, laboratory costs for urine samples (toxicology screens), methadone costs, and pharmacy costs. Pharmacy costs include dispensing fees and markups. All costs are expressed in 2010 Canadian dollars. Results: The database consisted of 9479 unique patients. The average age on the date of the first recorded visit was 34.3, and among the patients 62.3% were male. There were 6,425,937 patient days of treatment and the total cost of all treatment-related services was approximately $99,491,000. The total cost was comprised of physician billing (9.8%), pharmacy costs (39.8%), methadone (3.8%), and performing urine toxicology screens (46.7%). The average cost per day for treatment was $15.48, corresponding to $5651per year if patients were to remain in treatment continuously. Conclusions: The cost of providing methadone maintenance treatment in Ontario is comparable to estimates from the United States and Australia. Scientific Significance: This information is important to policy makers for planning and budgeting purposes and as part of a full cost–benefit or cost-effectiveness analysis of methadone treatment.

• methadone
• cost
• electronic medical record

ACKNOWLEDGMENTS

GSZ received support from the National Institute on Drug Abuse (DA-R01-15612). AWB received support from an NSERC Undergraduate Summer Research Award.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

1. Currency estimates from comparison studies were converted to equivalent 2010 Canadian dollars as follows. First, we applied the country-specific inflation rate to convert from the currency year stated in each study to 2010 in the relevant local currency units. Then we converted to Canadian dollars using to the mid-year exchange rate (2 July 2010). We note that there were considerable fluctuations in exchange rates during the last 15 years and if the two operations had been reversed (i.e., convert to Canadian dollars first, then inflate according to the Bank of Canada inflation rate), the comparison amounts would be different.

2. The cost estimate for methadone is based on mean cost of $1415 and mean of 113 days retention in treatment ($1415/113 = $12.52). The cost estimate for buprenorphine is based on and mean cost of $1729 and mean of 93 days retention in treatment ($1729/93 = $18.59).