Cost-effectiveness of substance abuse services: Implications for public policy

Abstract

The authors' general conclusion is that offering accessible 'regular outpatient' services is generally most cost-effective and that short-term rehabilitation for highest-severity substance-use patients is most cost- effective compared with a policy of engaging patients in detoxification alone. Perhaps most important, all treatment options for all patient groups, with one exception, were more effective than the baseline program of detoxification alone; however, uniformly placing individuals in more intensive types of treatment is not the most cost-effective strategy. Long- term rehabilitation provided the largest increment in effectiveness for lowest-severity and moderate-severity patients and the second largest effect increment for highest-severity patients; however, the costs per abstinence year were much higher than other treatment options. The authors' analysis controls for other patient characteristics that may influence both treatment effect and treatment costs. The authors estimated the net effectiveness of each type of treatment as the difference above the abstinence rate for detoxification alone. This approach provides a conservative estimate of the impact of treatment because it assumes that detoxification alone has no effect on long-term abstinence. These net effectiveness levels ranged from a 5.5-percentage-point increase for lowest-severity patients in intensive outpatient care to a 26.0-percentage-point increase for highest-severity patients in short-term rehabilitation. The authors computed cost- effectiveness as the cost per net effectiveness (abstinence) year. Using this approach, with a conservative measure of effectiveness, the most cost- effective strategies had costeffectiveness ratios of $7554 to $14,019 per abstinent year, for lowest-severity and middle-severity patients, respectively. Considering the social costs of substance abuse, these ratios demonstrate that further investment in treatment is a reasonable strategy. Expanding treatment types uniformly for highest-severity patients would be a less cost-effective strategy using this CEA ($18,912 per abstinent year); however, the authors further identified that the preferred treatment option for highest-severity patients, short-term rehabilitation, was the most effective and the most cost-effective treatment and would amount to only $4917 cost per patient, and the improvement gained would be 0.260 abstinent years over detoxification alone.