Cost and cost-effectiveness of interim methadone treatment and patient navigation initiated in jail

Drug Alcohol Depend. 2020 Dec 1;217:108292. doi: 10.1016/j.drugalcdep.2020.108292. Epub 2020 Sep 16.


Background: Individuals with opioid use disorder (OUD) who are released from pre-trial detention in jail have a high risk of opioid relapse. While several interventions for OUD initiated during incarceration have been studied, few have had an economic evaluation. As part of a three-group randomized trial, we estimated the cost and cost-effectiveness of a negative urine opioid test. Detainees were assigned to interim methadone (IM) in jail with continued methadone treatment post-release with and without 3 months of post-release patient navigation (PN) compared to an enhanced treatment-as-usual group.

Methods: We implemented a micro-costing approach from the provider's perspective to estimate the cost per participant in jail and over the 12 months post-release from jail. Economic data included jail-based and community-based service utilization, self-reported healthcare utilization and justice system involvement, and administrative arrest records. Our outcome measure is the number of participants with a negative opioid urine test at their 12-month follow-up. We calculated incremental cost-effectiveness ratios (ICERs) for intervention costs only and costs from a societal perspective.

Results: The average cost of providing patient navigation services per individual beginning in jail and continuing in the community was $283. We find that IM is dominated by ETAU and IM + PN. Per additional participant with a negative opioid urine test, the ICER for IM + PN including intervention costs only is $91 and $305 including societal costs.

Conclusions: IM + PN is almost certainly the cost-effective choice from both an intervention provider and societal perspective.

Keywords: Cost-effectiveness; Jail-Based; Methadone; Opioids; Patient navigation.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid / economics
  • Analgesics, Opioid / therapeutic use
  • Cost-Benefit Analysis* / methods
  • Female
  • Humans
  • Jails / economics*
  • Male
  • Methadone / economics*
  • Methadone / therapeutic use
  • Middle Aged
  • Opiate Substitution Treatment / economics*
  • Opiate Substitution Treatment / methods
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / economics*
  • Patient Acceptance of Health Care
  • Patient Navigation / economics*
  • Patient Navigation / methods
  • Treatment Outcome


  • Analgesics, Opioid
  • Methadone