Shepard DS, Larson MJ, Hodgkin D, Maynard DB; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 312-3.
Institute for Health Research, Heller School, Brandeis University, Waltham, MA 02454, USA.
RESEARCH OBJECTIVE: Funding for substance abuse treatment is often limited due to a perception that treatment is expensive and ineffective. To aid the allocation of its treatment funds, the state of Ohio commissioned a study to determine the cost-effectiveness of substance abuse treatment in facilities that obtain any public funding. The study sought to examine how cost-effectiveness varied by treatment modality and characteristics of the client. All drug free modalities were examined. STUDY DESIGN: Cost-effectiveness analysis, a technique for allocating resources, examines the relationship between the cost of providing a treatment and the resulting improvement in health measured in a single, numerical scale. In applying this concept to substance abuse services, we expressed effectiveness in terms of additional "abstinent years." We measured abstinent years in relation to a statistically matched clinet in a baseline program of detox only, with no rehabilitative treatment. This baseline is intended to approximate the outcome if a comparably motivated client were to receive no treatment. We applied the approach to 2941 clients in publicly funded treatment programs in Ohio from 1993 through 1995. We used the payment rates of the state's Medicaid population as a proxy for costs. To control for differences in clients across modalities, we used multivariate cost-effectiveness analysis, estimating results for a typical client at each of three alternative severity levels. PRINCIPAL FINDINGS: Long-term residential rehabilitation was the most expensive treatment type with an average cost of $8,629 per client (75 days at $115 per day). The cost per client of other treatments, in descending order, was: short-term residential rehabilitation ($3,453, based on 28 days at $124 per day), intensive outpatient ($1,788 based on 15.3 days at $117 per day), multi-transaction ($1,653 based on 22.8 days with an inpatient or ambulatory service at $72 per day), and regular outpatient ($1,050 based on 22.0 hours of individual and group counseling at $48 per hour. In all modalities, clients' reports of alcohol and drug use declined substantially after treatment. The analysis of client characteristics found that some types could be treated more cost-effectively than others. Having fewer than 5 symptoms of depression, working full-time, having a low frequency of substance use, and a low severity score were all associated with lower costs per abstinent year. For the two lower severity levels, regular outpatient care proved the most cost-effective modality. The cost of producing an additional abstinent year was $7600 for low severity clients and $14,000 for moderate severity clients. For the highest severity clients, however, short term rehabilitation proved most cost-effective ($18,900 per abstinent year), followed by intensive outpatient care ($23,000 per abstinent year). CONCLUSIONS: These results show that the cost-effectiveness of substance abuse treatment is commensurate with that of medical treatments. Rehabilitation is particularly cost-effective for the least severe clients, for whom a relatively inexpensive regular outpatient episode provides substantial benefit. This modality is the most cost-effective setting for all but the most severe clients. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Those responsible for allocating substance abuse treatment may wish to favor clients who respond well to inexpensive treatment. Substance abuse treatment is a reasonable investment, as rehavilitation benefits both the client and society generally.
Publication Types:
Keywords:
- Ambulatory Care
- Case-Control Studies
- Cost-Benefit Analysis
- Costs and Cost Analysis
- Health Expenditures
- Humans
- Inpatients
- Medicaid
- Mental Disorders
- Ohio
- Outpatients
- Substance-Related Disorders
- economics
- rehabilitation
- therapy
- hsrmtgs
Other ID:
UI: 102194663
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