Building a microsimulation model of heroin use careers in Australia

Illicit heroin use is a worldwide problem, with significant health and social costs. Treatment is known to be effective in changing heroin use habits, but it often needs to be provided over a lifetime, with people cycling in and out of treatment. It is therefore important to capture a long-term perspective on heroin use careers. The aim of this project was to build a lifetime microsimulation model of heroin using careers. This paper describes the conceptual logic of the model, the input parameters and the verification and validation results. A microsimulation model was chosen as the most appropriate simulation platform with 9 states, and 111,400 individuals (aged between 18 and 60) each with gender, HIV (human immunodeficiency virus) and HCV (hepatitis C) status, and treatment history. Probabilities associated with crime commission and individually calculated lengths of stay in each state were determined from multiple datasets. The model included costs associated with treatment provision, healthcare services, criminal activity, life years lost, and family benefit of treatment. The final model represented 42 years of a heroin use career for a cohort based on Australian (New South Wales) data. Individuals cycle into and out of heroin using states (including abstinence), as well as treatment and prison states. We were able to build a stable, tractable model and verified all parameters. Validation against external data sources revealed high validity. While there are limitations associated with any model, the heroin career model now has the potential to be used for simulations of alternate policy scenarios.