Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico

Authors

Brady P. Horn, Department of Economics, University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
Xiaoxue Li, Department of Economics, University of New Mexico, Albuquerque, NM, USA
Barbara McCrady, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
Paul Guerin, The Institute for Social Research, The University of New Mexico, Albuquerque, NM, USA
Michael T. French, Department of Health Management and Policy, Miami Herbert Business School, University of Miami, Coral Gables, FL, USA

Document Type

Article

Publication Date

8-2020

Abstract

The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.

Recommended Citation

Brady P. Horn, Xiaoxue Li, Barbara McCrady, Paul Guerin, Michael T. French, Cost-effectiveness analysis of a large jail-based methadone maintenance treatment continuation program in New Mexico, Journal of Substance Abuse Treatment, Volume 115, 2020, 108042, ISSN 0740-5472, https://doi.org/10.1016/j.jsat.2020.108042.