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

Addiction

Volumn 107, Issue 3, 2012, Pages 624-634

  Stephen, James H ^a   Halpern, Casey H ^a   Barrios, Cristian J ^a   Balmuri, Usha ^a   Pisapia, Jared M ^a   Wolf, John A ^a   Kampman, Kyle M ^b   Baltuch, Gordon H ^a   Caplan, Arthur L ^a   Stein, Sherman C ^a  

^a HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

Cost effectiveness; Deep brain stimulation; Heroin dependence; Methadone; Quality of life

Indexed keywords

METHADONE; NARCOTIC AGENT;

BRAIN DEPTH STIMULATION; CLINICAL TRIAL (TOPIC); COMPARATIVE STUDY; COST BENEFIT ANALYSIS; DECISION SUPPORT SYSTEM; ECONOMICS; HEROIN DEPENDENCE; HUMAN; META ANALYSIS; METHODOLOGY; QUALITY ADJUSTED LIFE YEAR; QUALITY OF LIFE; REVIEW;

CLINICAL TRIALS AS TOPIC; COST-BENEFIT ANALYSIS; DECISION SUPPORT TECHNIQUES; DEEP BRAIN STIMULATION; HEROIN DEPENDENCE; HUMANS; METHADONE; NARCOTICS; QUALITY OF LIFE; QUALITY-ADJUSTED LIFE YEARS;

EID: 83155193847     PISSN: 09652140     EISSN: 13600443     Source Type: Journal    
DOI: 10.1111/j.1360-0443.2011.03656.x     Document Type: Article

References (83)

1. Gunne L. M., Gronbladh L. The Swedish methadone maintenance program: a controlled study. Drug Alcohol Depend 1981; 7: 249-56.
2. Hubbard R. L., Craddock S. G., Anderson J. Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS). J Subst Abuse Treat 2003; 25: 125-34.
3. Substance Abuse and Mental Health Services Administration. Results from the 2009 National survey on drug use and health: volume I. Summary of national findings. 2010; HHS Publication no. SMA 10-4586.
4. Mattick R. P., Kimber J., Breen C., Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008; 2: CD002207.
5. Dole V. P., Nyswander M. A medical treatment for Diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. JAMA 1965; 193: 646-50.
6. Freedman R. R., Czertko G. A comparison of thrice weekly LAAM and daily methadone in employed heroin addicts. Drug Alcohol Depend 1981; 8: 215-22.
7. Halpern C., Hurtig H., Jaggi J., Grossman M., Won M., Baltuch G. Deep brain stimulation in neurologic disorders. Parkinsonism Relat Disord 2007; 13: 1-16.
8. Kramer D. R., Halpern C. H., Buonacore D. L., McGill K. R., Hurtig H. I., Jaggi J. L. etal. Best surgical practices: a stepwise approach to the University of Pennsylvania deep brain stimulation protocol. Neurosurg Focus 2010; 29: E3.
9. Kerrigan J. F., Litt B., Fisher R. S., Cranstoun S., French J. A., Blum D. E. etal. Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia 2004; 45: 346-54.
10. Franzini A., Messina G., Cordella R., Marras C., Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus 2010; 29: E13.
11. Greenberg B. D., Malone D. A., Friehs G. M., Rezai A. R., Kubu C. S., Malloy P. F. etal. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology 2006; 31: 2384-93.
12. Schlaepfer T. E., Cohen M. X., Frick C., Kosel M., Brodesser D., Axmacher N. etal. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 2008; 33: 368-77.
13. Halpern C. H., Wolf J. A., Bale T. L., Stunkard A. J., Danish S. F., Grossman M. etal. Deep brain stimulation in the treatment of obesity. J Neurosurg 2008; 109: 625-34.
14. Pisapia J. M., Halpern C. H., Williams N. N., Wadden T. A., Baltuch G. H., Stein S. C. Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study. Neurosurg Focus 2010; 29: E15.
15. Lee K. H., Roberts D. W., Kim U. Effect of high-frequency stimulation of the subthalamic nucleus on subthalamic neurons: an intracellular study. Stereotact Funct Neurosurg 2003; 80: 32-6.
16. McIntyre C. C., Savasta M., Kerkerian-Le Goff L., Vitek J. L. Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both. Clin Neurophysiol 2004; 115: 1239-48.
17. Follett K. A., Weaver F. M., Stern M., Hur K., Harris C. L., Luo P. etal. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 2010; 362: 2077-91.
18. Rogers J. L., Ghee S., See R. E. The neural circuitry underlying reinstatement of heroin-seeking behavior in an animal model of relapse. Neuroscience 2008; 151: 579-88.
19. Kalivas P. W., Stewart J. Dopamine transmission in the initiation and expression of drug- and stress-induced sensitization of motor activity. Brain Res Rev 1991; 16: 223-44.
20. Boileau I., Dagher A., Leyton M., Welfeld K., Booij L., Diksic M. etal. Conditioned dopamine release in humans: a positron emission tomography [11C]raclopride study with amphetamine. J Neurosci 2007; 27: 3998-4003.
21. Henderson M. B., Green A. I., Bradford P. S., Chau D. T., Roberts D. W., Leiter J. C. Deep brain stimulation of the nucleus accumbens reduces alcohol intake in alcohol-preferring rats. Neurosurg Focus 2010; 29: E12.
22. Knapp C. M., Tozier L., Pak A., Ciraulo D. A., Kornetsky C. Deep brain stimulation of the nucleus accumbens reduces ethanol consumption in rats. Pharmacol Biochem Behav 2009; 92: 474-9.
23. Vassoler F. M., Schmidt H. D., Gerard M. E., Famous K. R., Ciraulo D. A., Kornetsky C. etal. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. J Neurosci 2008; 28: 8735-9.
24. Liu H. Y., Jin J., Tang J. S., Sun W. X., Jia H., Yang X. P. etal. Chronic deep brain stimulation in the rat nucleus accumbens and its effect on morphine reinforcement. Addict Biol 2008; 13: 40-6.
25. Heinze H. J., Heldmann M., Voges J., Hinrichs H., Marco-Pallares J., Hopf J. M. etal. Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: clinical and basic science aspects. Front Hum Neurosci 2009; 3: 22.
26. Mantione M., van de Brink W., Schuurman P. R., Denys D. Smoking cessation and weight loss after chronic deep brain stimulation of the nucleus accumbens: therapeutic and research implications: case report. Neurosurgery 2010; 66: E218, discussion E218.
27. Muller U. J., Sturm V., Voges J., Heinze H. J., Galazky I., Heldmann M. etal. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry 2009; 42: 288-91.
28. Kuhn J., Bauer R., Pohl S., Lenartz D., Huff W., Kim E. H. etal. Observations on unaided smoking cessation after deep brain stimulation of the nucleus accumbens. Eur Addict Res 2009; 15: 196-201.
29. Mueller B. R., Bale T. L. Sex-specific programming of offspring emotionality after stress early in pregnancy. J Neurosci 2008; 28: 9055-65.
30. Nestler E. J., Barrot M., DiLeone R. J., Eisch A. J., Gold S. J., Monteggia L. M. Neurobiology of depression. Neuron 2002; 34: 13-25.
31. Connock M., Juarez-Garcia A., Jowett S., Frew E., Liu Z., Taylor R. J. etal. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess 2007; 11: 1-171, iii-iv.
32. Oviedo-Joekes E., Guh D., Brissette S., Marchand K., Marsh D., Chettiar J. etal. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women. Drug Alcohol Depend 2010; 111: 50-7.
33. Torrens M., Domingo-Salvany A., Alonso J., Castillo C., San L. Methadone and quality of life. Lancet 1999; 353: 1101.
34. Blanken P., Hendriks V. M., van Ree J. M., van den Brink W. Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands. Addiction 2010; 105: 300-8.
35. Carpentier P. J., Krabbe P. F., van Gogh M. T., Knapen L. J., Buitelaar J. K., de Jong C. A. Psychiatric comorbidity reduces quality of life in chronic methadone maintained patients. Am J Addict 2009; 18: 470-80.
36. Harris A. H., Gospodarevskaya E., Ritter A. J. A randomised trial of the cost-effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting. Pharmacoeconomics 2005; 23: 77-91.
37. Puigdollers E., Domingo-Salvany A., Brugal M. T., Torrens M., Alvaros J., Castillo C. etal. Characteristics of heroin addicts entering methadone maintenance treatment: quality of life and gender. Subst Use Misuse 2004; 39: 1353-68.
38. Xiao L., Wu Z., Luo W., Wei X. Quality of life of outpatients in methadone maintenance treatment clinics. J Acquir Immune Defic Syndr 2010; 53: S116-20.
39. Astals M., Domingo-Salvany A., Buenaventura C. C., Tato J., Vazquez J. M., Martin-Santos R. etal. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst Use Misuse 2008; 43: 612-32.
40. Einarson T. R. Pharmacoeconomic applications of meta-analysis for single groups using antifungal onychomycosis lacquers as an example. Clin Ther 1997; 19: 559-69. discussion 538-9.
41. King J. T. Jr, Berlin J. A., Flamm E. S. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg 1994; 81: 837-42.
42. Centers for Medicare and Medicaid Services. CY 2011 Physician Fee Schedule Final Rule. 2011. Available at:, archived at: (accessed 1 March 2011).
43. Center for Medicare and Medicaid Services. CY 2011 Medicare Hospital Prospective Payment System. 2011. Available at:, archived at: (accessed 1 March 2011).
44. Office of National Drug Control Policy. The economic costs of drug abuse in the United States, 1992-2002. 2004; Publication no. 207303.
45. Bureau of Labor Statistics. Consumer Price Index Detailed Report, 2011. Available at:, archived at: (accessed 1 March 2011).
46. Duriseti R. S., Brandeau M. L. Cost-effectiveness of strategies for diagnosing pulmonary embolism among emergency department patients presenting with undifferentiated symptoms. Ann Emerg Med 2010; 56: 321-332.e10.
47. Goodacre S., Sampson F., Stevenson M., Wailoo A., Sutton A., Thomas S. etal. Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis. Health Technol Assess 2006; 10: 1-168, iii-iv.
48. Ivanova J. I., Birnbaum H. G., Kidolezi Y., Qiu Y., Mallett D., Caleo S. Economic burden of epilepsy among the privately insured in the US. Pharmacoeconomics 2010; 28: 675-85.
49. Mercaldi C. J., Ciarametaro M., Hahn B., Chalissery G., Reynolds M. W., Sander S. D. etal. Cost efficiency of anticoagulation with warfarin to prevent stroke in Medicare beneficiaries with nonvalvular atrial fibrillation. Stroke 2011; 42: 112-8.
50. Ott E., Bange F. C., Reichardt C., Graf K., Eckstein M., Schwab F. etal. Costs of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus. J Hosp Infect 2010; 76: 300-3.
51. Gold M. R., Siegel J. A., Russel L. B., Weinstein M. C., editors. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
52. Bell J., Caplehorn J. R., McNeil D. R. The effect of intake procedures on performance in methadone maintenance. Addiction 1994; 89: 463-71.
53. Fiellin D. A., O'Connor P. G., Chawarski M., Pakes J. P., Pantalon M. V., Schottenfeld R. S. Methadone maintenance in primary care: a randomized controlled trial. JAMA 2001; 286: 1724-31.
54. Fischer G., Jagsch R., Eder H., Gombas W., Etzersdorfer P., Schmidl-Mohl K. etal. Comparison of methadone and slow-release morphine maintenance in pregnant addicts. Addiction 1999; 94: 231-9.
55. Gordon M. S., Kinlock T. W., Schwartz R. P., O'Grady K. E. A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post-release. Addiction 2008; 103: 1333-42.
56. Kakko J., Gronbladh L., Svanborg K. D., von Wachenfeldt J., Ruck C., Rawlings B. etal. A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence: a randomized controlled trial. Am J Psychiatry 2007; 164: 797-803.
57. King V. L., Stoller K. B., Hayes M., Umbricht A., Currens M., Kidorf M. S. etal. A multicenter randomized evaluation of methadone medical maintenance. Drug Alcohol Depend 2002; 65: 137-48.
58. Kosten T. R., Schottenfeld R., Ziedonis D., Falcioni J. Buprenorphine versus methadone maintenance for opioid dependence. J Nerv Ment Dis 1993; 181: 358-64.
59. Ling W., Wesson D. R., Charuvastra C., Klett C. J. A controlled trial comparing buprenorphine and methadone maintenance in opioid dependence. Arch Gen Psychiatry 1996; 53: 401-7.
60. Longshore D., Annon J., Anglin M. D., Rawson R. A. Levo-alpha-acetylmethadol (LAAM) versus methadone: treatment retention and opiate use. Addiction 2005; 100: 1131-9.
61. Schottenfeld R. S., Chawarski M. C., Pakes J. R., Pantalon M. V., Carroll K. M., Kosten T. R. Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry 2005; 162: 340-9.
62. Schottenfeld R. S., Pakes J. R., Oliveto A., Ziedonis D., Kosten T. R. Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry 1997; 54: 713-20.
63. Sees K. L., Delucchi K. L., Masson C., Rosen A., Clark H. W., Robillard H. etal. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA 2000; 283: 1303-10.
64. Strain E. C., Stitzer M. L., Liebson I. A., Bigelow G. E. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psychiatry 1994; 151: 1025-30.
65. Strang J., Marsden J., Cummins M., Farrell M., Finch E., Gossop M. etal. Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome. Addiction 2000; 95: 1631-45.
66. Strang J., Metrebian N., Lintzeris N., Potts L., Carnwath T., Mayet S. etal. Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): a randomised trial. Lancet 2010; 375: 1885-95.
67. Barnett P. G., Trafton J. A., Humphreys K. The cost of concordance with opiate substitution treatment guidelines. J Subst Abuse Treat 2010; 39: 141-9.
68. Braithwaite R. S., Meltzer D. O., King J. T. Jr, Leslie D., Roberts M. S. What does the value of modern medicine say about the $50000 per quality-adjusted life-year decision rule? Med Care 2008; 46: 349-56.
69. Mayberg H. S., Lozano A. M., Voon V., McNeely H. E., Seminowicz D., Hamani C. etal. Deep brain stimulation for treatment-resistant depression. Neuron 2005; 45: 651-60.
70. Bewernick B. H., Hurlemann R., Matusch A., Kayser S., Grubert C., Hadrysiewicz B. etal. Nucleus accumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biol Psychiatry 2010; 67: 110-6.
71. Meissner W., Schreiter D., Volkmann J., Trottenberg T., Schneider G. H., Sturm V. etal. Deep brain stimulation in late stage Parkinson's disease: a retrospective cost analysis in Germany. J Neurol 2005; 252: 218-23.
72. Hall W., Carter A. Is deep brain stimulation a prospective 'cure' for addiction? F1000 Med Rep 2011; 3: 4.
73. Carter A., Hall W. Proposals to trial deep brain stimulation to treat addiction are premature. Addiction 2011; 106: 235-7.
74. Carter A., Bell E., Racine E., Hall W. Ethical issues raised by proposals to treat addiction using deep brain stimulation. Neuroethics 2011; 4: 129-42.
75. Hall W., Carter A. Deep brain stimulation in Parkinsonian patients-implications for trialing DBS in intractable psychiatric disorders. AJOB Neurosci 2011; 2: 14-5.
76. Schlaepfer T. E., Fins J. J. Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough. JAMA 2010; 303: 775-6.
77. McLellan A. T., Lewis D. C., O'Brien C. P., Kleber H. D. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA 2000; 284: 1689-95.
78. Anglin M. D., Conner B. T., Annon J., Longshore D. Levo-alpha-acetylmethadol (LAAM) versus methadone maintenance: 1-year treatment retention, outcomes and status. Addiction 2007; 102: 1432-42.
79. Oviedo-Joekes E., Brissette S., Marsh D. C., Lauzon P., Guh D., Anis A. etal. Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med 2009; 361: 777-86.
80. Vigezzi P., Guglielmino L., Marzorati P., Silenzio R., De Chiara M., Corrado F. etal. Multimodal drug addiction treatment: a field comparison of methadone and buprenorphine among heroin- and cocaine-dependent patients. J Subst Abuse Treat 2006; 31: 3-7.
81. Oviedo-Joekes E., March J. C., Romero M., Perea-Milla E. The Andalusian trial on heroin-assisted treatment: a 2 year follow-up. Drug Alcohol Rev 2010; 29: 75-80.
82. Verthein U., Bonorden-Kleij K., Degkwitz P., Dilg C., Kohler W. K., Passie T. etal. Long-term effects of heroin-assisted treatment in Germany. Addiction 2008; 103: 960-6. discussion 967-8.
83. Oviedo-Joekes E., Nosyk B., Marsh D. C., Guh D., Brissette S., Gartry C. etal. Scientific and political challenges in North America's first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: rationale and design of the NAOMI study. Clin Trials 2009; 6: 261-71.