Benefit-cost in the California treatment outcome project: Does substance abuse treatment "pay for itself"?

被引:117
作者
Ettner, SL
Huang, D
Evans, E
Ash, DR
Hardy, M
Jourabchi, M
Hser, YI
机构
[1] Univ Calif Los Angeles, Div Gen Internal Med, Los Angeles, CA 90095 USA
[2] Univ Calif Los Angeles, David Geffen Sch Med, Hlth Serv Res, Los Angeles, CA 90095 USA
[3] Univ Calif Los Angeles, Integrated Subst Abuse Program, Los Angeles, CA 90024 USA
关键词
substance abuse treatment; costs; cost-offset;
D O I
10.1111/j.1475-6773.2005.00466.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective. To examine costs and monetary benefits associated with substance abuse treatment. Data Sources. Primary and administrative data on client outcomes and agency costs from 43 substance abuse treatment providers in 13 counties in California during 2000-2001. Study Design. Using a social planner perspective, the estimated direct cost of treatment was compared with the associated monetary benefits, including the client's costs of medical care, mental health services, criminal activity, earnings, and (from the government's perspective) transfer program payments. The cost of the client's substance abuse treatment episode was estimated by multiplying the number of days that the client spent in each treatment modality by the estimated average per diem cost of that modality. Monetary benefits associated with treatment were estimated using a pre-posttreatment admission study design, i.e., each client served as his or her own control. Data Collection. Treatment cost data were collected from providers using the Drug Abuse Treatment Cost Analysis Program instrument. For the main sample of 2,567 clients, information on medical hospitalizations, emergency room visits, earnings, and transfer payments was obtained from baseline and 9-month follow-up interviews, and linked to information on inpatient and outpatient mental health services use and criminal activity from administrative databases. Sensitivity analyses examined administrative data outcomes for a larger cohort (N = 6,545) and longer time period (1 year). Principal Findings. On average, substance abuse treatment costs $1,583 and is associated with a monetary benefit to society of $11,487, representing a greater than 7:1 ratio of benefits to costs. These benefits were primarily because of reduced costs of crime and increased employment earnings. Conclusions. Even without considering the direct value to clients of improved health and quality of life, allocating taxpayer dollars to substance abuse treatment may be a wise investment.
引用
收藏
页码:192 / 213
页数:22
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