Australian Drug and Alcohol Review 1989; 8:35-37 The cost of the Western Australian methadone program Greg Swensen William Street Clinic, 354 William Street, Perth, Western Australia Introduction This paper reports the results of a study of the cost of the Western Australian (WA) methadone program during 1986. The only known published study analysing the cost of methadone treatment in Australia is a com- .parative study of private and public prescribers xn a one month period in New South Wales (NSW). 1 The paper identifies some of the con- straints in which the WA program operates and suggests that in the future, efficient use of limited public resources will have to become a greater concern to administrators, policy makers and practitioners. Options proposed include the allocation of public resources to specific stages of the treatment cycle, in con- junction with private practitioner management, and the possibility of client fees for doses. The rationale for these options is cost effectiveness, client choice of treatment, client contribution to the cost of medication (methadone), and the need to finance expansion of the service. Description of the program For the past decade the methadone program has been wholly operated by a statutory agency, the WA Alcohol and Drug Authority (ADA). Prior to 1978 methadone was pre- scribed largely by private practitioners with few clients participating in the public program. The earlier arrangement in WA of dual private and public prescribing proved to be unworkable because of the extensive diversion of doses, over-prescribing of high doses and lack of stan- dard procedures to prevent non-addicted persons receiving methadone. The WA program is currently conducted from a specific facility, the William Street Clinic (WSC) in Perth. After admission at WSC clients may receive methadone outside the metropolitan area from retail pharmacies and regional hospitals, or at a number of retail pharmacies in the metropolitan area. The feature of the WA program is that the prescrip- tion, supply and ongoing supervision of methadone treatment is conducted through WSC, with flexible dispensing options throughout the State. A significant difficulty in running a program in WA is the sheer size of the State. WA occupies 32.9% of the area of Australia but has only 9.0% of the nation's population, while 71.2% of the population live in the metro- politan area. There are therefore administrative problems m operating a program which requires doses to be provided to clients work- ing in country towns. Results An advantage of the centralised nature of the WA program is that it is possible to obtain very detailed accounts of clients' treatment histories; accurate costings of the program can therefore be made. Costing was calculated under the five major headings in Table 1. Salaries and wages constituted 77.5 % of total costs in the 12 month period. There were 562 persons who participated in the program during 1986. They received 107,469 daily doses, of which 71,409 (67.1%) were dispensed from WSC. The remaining 36,060 daily doses were dispensed from non- ADA facilities. The quantity of methadone dispensed was 4.98 kgs, ie a mean dose of 46.3 rag. These 562 clients had an aggregate of 3,903 treatment months in 1986. The mean annual cost of treatment of the 562 participants in the WA methadone program was $i,584. The mean cost per client per month was $222.86, based on a mean cost of $74,211 per month and a mean of 333 clients per month. The mean cost of a daily dose of methadone was $8.29. There was a bimodal distribution of dura- tion of treatment (Table 2); nearly half the clientele had been in treatment for six months or less.