Purpose. The absence of utility values has prevented cost-utility analysis of treatments for opiate dependence. We assessed utilities in individuals with active opiate dependence disorder.

Method. The modified Addiction Severity Index (ASI) and six quality of life measures were used to assess quality of life of residents of the Tenderloin neighborhood in San Francisco who provided a history and objective signs of current and sustained illicit opiate use. Individuals were excluded for inability to speak coherently, aggressiveness, objective evidence of being of acutely intoxicated with alcohol or heroin, or suffering severe withdrawal.

Results. Participants (N=49) reported that in the prior 30 days, they had used heroin on average of 26.2 days, and cocaine on 15.8 days. Respondents reported a mean utility of 0.518 by Quality of Well Being (QWB) scale, 0.545 by Health Utilities Index (HUI), 0.760 by EuroQuol (EQ5-D), 0.768 by Standard Gamble (SG), and 0.773 on the Time Trade Off (TTO). Their mean value on the Visual Analog Scale was 0.632. Values of indirect utility measures (the VAS, HUI, QWB, and EQ-5D) were significantly correlated. Only 3 of the 9 correlations that involved the direct measures, the TTO and SG, were significant. There were significant relationships between drug and mental health problems and utility. We regressed utility scores on the ASI drug problem score, the ASI psychiatric problem score, and an indicator of HIV positive status. A higher psychiatric problem score was associated with significantly lower utility by 5 of the 6 measures. A higher drug problem score was associated with significantly lower utility by EQ-5D and QWB.

Conclusion: Economic evaluations of drug treatment have been largely limited to cost-benefit analysis, considering reduction in criminal justice costs but not the effect of treatment on improved quality of life or mortality. We found that utilities can be assessed in drug users and that opiate dependence has a severe impact on quality of life. It thus appears feasible to use cost-utility analysis to evaluate innovation, enhancement, or expansion of substance abuse treatment. This type of analysis will allow decision makers to compare the incremental cost per QALY of changes in substance abuse treatment in parity with the economic evaluations of medical care interventions.