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Scale\u2010up is limited by both OAT availability and demand. This study aimed to evaluate the cost\u2010effectiveness of a range of plausible OAT scale\u2010up strategies in Ukraine incorporating the potential impact of treatment spillover and the real\u2010world demand for addiction treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>Ten\u2010year horizon (2016\u201325) modeling study of opioid addiction epidemic and treatment that accommodated potential peer effects in opioid use initiation and supply\u2010induced treatment demand in three Ukrainian cities: Kyiv, Mykolaiv and Lviv, comprising a simulated population of people at risk of and with OUD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Incremental cost per quality\u2010adjusted life\u2010year gained in the simulated population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>An estimated 12.2\u2010, 2.4\u2010 and 13.4\u2010fold OAT capacity increase over 2016 baseline capacity in Kyiv, Mykolaiv and Lviv, respectively, would be cost\u2010effective at a willingness\u2010to\u2010pay of one per\u2010capita gross domestic product (GDP) per quality\u2010adjusted life\u2010year gained. This result is robust to parametric and structural uncertainty. Even under the most ambitious capacity increase, OAT coverage (i.e. the proportion of people with OUD receiving OAT) over a 10\u2010year modeling horizon would be 20, 11 and 17% in Kyiv, Mykolaiv and Lviv, respectively, owing to limited demand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It is estimated that a substantial increase in opioid agonist treatment (OAT) capacity in three Ukrainian cities would be cost\u2010effective for a wide range of willingness\u2010to\u2010pay thresholds. Even a very ambitious capacity increase, however, is unlikely to reach internationally recommended coverage levels. Further increases in coverage may be limited by demand and would require addressing existing structural barriers to OAT access.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14797","type":"journal-article","created":{"date-parts":[[2019,9,3]],"date-time":"2019-09-03T07:53:35Z","timestamp":1567497215000},"page":"437-450","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Cost\u2010effectiveness of expanding the capacity of opioid agonist treatment in Ukraine: dynamic modeling analysis"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7606-8413","authenticated-orcid":false,"given":"Olga","family":"Morozova","sequence":"first","affiliation":[{"name":"Department of Biostatistics Yale School of Public Health New Haven CT USA"},{"name":"Department of Epidemiology of Microbial Diseases Yale School of Public Health New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0046-0547","authenticated-orcid":false,"given":"Forrest W.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Yale School of Public Health New Haven CT USA"},{"name":"Department of Ecology and Evolutionary Biology Yale University New Haven CT USA"},{"name":"Department of Statistics and Data Science Yale University New Haven CT USA"},{"name":"Yale School of Management New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8091-7198","authenticated-orcid":false,"given":"Ted","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases Yale School of Public Health New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4861-3290","authenticated-orcid":false,"given":"A. 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