The financial impact of maintenance treatment in heroin addictive behavior:: the case of Subutex®

Background: The development of maintenance treatment for subjects with addictive behavior is an important public health issue. As such, the social effectiveness of maintenance products must be examined from an economical and social point of view. This paper aims at presenting the financial costs involved in the use of Subutex(R), a product commercialized since 1996. Methods: A complete typology of costs related to drug addiction and its consequences was set up. Some of these costs were estimated on the basis of data drawn from the literature. The cost of Subutex(R) use fbr maintenance treatment was assessed and compared with the financial stakes including the potential reduction of the economic and social cost of drug addiction. Results: Monthly treatment cost of Subutex(R) was 1252 FrF per drug abuser on maintenance treatment. By extrapolation, for a population of 40,000 drug abusers, the direct medical cost of Subutex(R) during a course of maintenance treatment with general practitioner follow-up was estimated at 600 millions FrF. US data sources were applied to France to assess the cost of illnesses attributable to drug addiction. The cost reached 4.8 billions FrF. The cost of delinquency associated with drug addiction, which mostly concerns money laundered to purchase substances was an estimated 6.4 billions FrF. Finally, the cost of public anti-drug abuse programs was nearly 4.7 billions FrF. Thus, the direct cost of drug addiction consequences reached 15.6 billions FrF. This cost should be compared with the annual cost of Subutex(R) for public organizations which was an estimated 600 millions FrF. Conclusions: The "profit" threshold of maintenance treatment with Subutex(R) in terms of direct costs is very low. A decrease of only 4% of the costs associated with drug addiction would make it possible to balance the financial budget for the community. Our analysis does not take into acount absolutely all the public health and safety aspects involved in the use of Subutex(R). It does however provide a useful assessment of the financial aspects of the question and justification for this therapeutic strategy from a budgetary point of view.