Drug Abuse Treatment Cost Analysis Program Research Articles

The economic costs of jail-based methadone maintenance treatment

ABSTRACTBackground: The US has the highest incarceration rate in the world and spends $40–$80 billion to house inmates per year. It is well-known that a significant correlation is present between substance use and crime, especially over recent years as opioid use disorder (OUD) has grown exponentially. To mitigate OUD, methadone maintenance treatment (MMT) has demonstrated effectiveness in numerous randomized and quasi-experimental studies. A potentially fruitful environment for MMT is correctional facilities, particularly short-term facilities, such as city and county jails. However, little is known about the economic implications of MMT within correctional facilities. Objective: The aim of the present study was to estimate the economic costs of jail-based MMT using data from a novel, established MMT program located within a large urban jail in New Mexico. Methods: Data were collected using administrative records and by interviewing program administrators using a modified version of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Both sensitivity analysis and cost-structure analysis were conducted to gauge the robustness of the findings. Results: The average (per patient) weekly cost of MMT is $115 and the total treatment cost for an average treatment episode is $689. These costs are generally in-line with non-jail-based MMT programs of similar size. Weekly cost estimates range from $86 to $185 depending on the size of the treatment facility, with larger programs exhibiting lower per-patient costs. Conclusion: Results provide a valuable economic benchmark to policy makers, criminal justice officials, and program administrators considering establishing and/or expanding MMT in jail settings.

Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults

IntroductionThe study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period. MethodsIntervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. ResultsFrom the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. ConclusionsTelephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. Clinical trial registrationClinical Trials.gov Number: NCT00685659.

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

Cost estimation when time and resources are limited: The Brief DATCAP

The Drug Abuse Treatment Cost Analysis Program (DATCAP) was designed in the early 1990s as a research guide to collect and analyze financial data from addiction treatment programs. The addiction research community could clearly benefit from a version of the DATCAP that reduced the time and effort required for its administration without compromising the integrity of its cost estimates. This paper introduces the Brief DATCAP and presents some preliminary findings. Initial feedback from respondents suggests that the Brief DATCAP is understandable, and easier and quicker to complete than the DATCAP. More importantly, preliminary results indicate that cost estimates from the Brief DATCAP differ from those of the longer DATCAP by less than 2%. These results have important research and policy implications because a shorter yet reasonably accurate cost instrument will enhance the feasibility and precision of future economic evaluations of addiction interventions.

Cost-effectiveness analysis of addiction treatment: paradoxes of multiple outcomes

This paper identifies and illustrates the challenges of conducting cost-effectiveness analysis (CEA) of addiction treatments given the multiple important outcomes of substance abuse treatment (SAT). Potential problems arise because CEA is intended primarily for single outcome programs, yet addiction treatment results in a variety of outcomes such as reduced drug use and crime and increased employment. Methodological principles, empirical examples, and practical advice are offered on how to conduct an economic evaluation given multiple outcomes. An empirical example is provided to illustrate some of the conflicts in cost-effectiveness (CE) ratios that may arise across the range of outcomes. The data are from the Philadelphia Target Cities quasi-experimental field study of standard versus “enhanced” (e.g. case management and added social services) drug treatment. Outcomes are derived from of the Addiction Severity Index (ASI), while cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program (DATCAP). While the results are illustrative only, they indicate that cost-effectiveness ratios for each of several different outcomes can produce conflicting implications. These findings suggest that multiple outcomes should be considered in any economic analysis of addiction treatments because focusing on a single outcome may lead to inadequate and possibly incorrect policy inferences. However, incorporating multiple outcomes into a CEA of addiction treatment is difficult. Cost-benefit analysis (CBA) may be a preferable and more appropriate approach in some cases.

Outpatient marijuana treatment for adolescents. Economic evaluation of a multisite field experiment.

An economic evaluation of five outpatient adolescent treatment approaches (12 total site-by-conditions) was conducted. The economic cost of each of the 12 site-specific treatment conditions was determined by the Drug Abuse Treatment Cost Analysis Program (DATCAP). Economic benefits of treatment were estimated by first monetizing a series of treatment outcomes and then analyzing the magnitude of these monetized outcomes from baseline through the 12-month follow-up. The average economic costs ranged from $90 to $313 per week and from $839 to $3,279 per episode. Relative to the quarter before intake, the average quarterly cost to society for the next 12 months (including treatment costs) significantly declined in 4 of the 12 site-by-treatment conditions, remained unchanged in 6 conditions, and increased in 2 treatment conditions (both in the same site). These results suggest that some types of substance-abuse intervention for adolescents can reduce social costs immediately after treatment.

DATStats: results from 85 studies using the Drug Abuse Treatment Cost Analysis Program (DATCAP)

The Drug Abuse Treatment Cost Analysis Program (DATCAP) was developed and launched in the early 1990s to help addiction researchers and administrators estimate the economic costs of substance abuse interventions. This paper presents summary results from 85 DATCAPs completed over the past 10 years. After first grouping the DATCAPs into 9 treatment modalities, cost measures (normalized to 2001 dollars) are reported along with client caseload information. Additionally, the distribution of costs across 6 resource categories is presented for each of the treatment modalities. The average weekly economic cost per client ranged from $82 per week for outpatient drug court interventions to $1,138 per week for adolescent residential treatment. As expected, labor was overwhelmingly the most utilized resource across all modalities, ranging from 48% to 88% of total economic cost. Addiction researchers, program administrators, and policymakers now have cost estimates and resource distribution information for various treatment modalities serving diverse populations.

Estimating the client costs of addiction treatment: first findings from the client drug abuse treatment cost analysis program (Client DATCAP)

The costs of addiction treatment services are an important determinant of the cost-effectiveness of a program, and therefore, of relevance to addiction treatment providers, insurance companies and, patients. Several methods have been developed to estimate the costs of substance abuse treatment services. One such method is the drug abuse treatment cost analysis program (DATCAP), which collects resource use and cost data from the treatment program perspective and has been used in numerous published economic evaluation studies. However, no single widely-used, standardized instrument is currently available to estimate costs specifically incurred by clients in treatment. In response to that need, this article introduces the Client DATCAP and presents process, survey-specific, and quantitative findings from a Pilot Study to estimate the client costs of attending outpatient and inpatient treatment. The preliminary findings suggest that the self-administered Client DATCAP is a feasible and practical instrument for estimating costs incurred by clients in treatment, with completion time amounting to less than 10 min. Furthermore, client costs had a considerable range across respondents, with time costs consistently accounting for the largest cost component. Findings from the Pilot Study led to the development and release of edition 2 of the outpatient and inpatient modules of the Client DATCAP.

The economic cost of outpatient marijuana treatment for adolescents: findings from a multi‐site field experiment

Despite recent advances in the economic evaluation of adult substance abuse treatment, information and basic research is lacking on the cost of adolescent substance abuse treatment. The present study conducted an economic cost analysis of several outpatient adolescent treatment approaches. The Cannabis Youth Treatment (CYT) study evaluated five structured treatments for cannabis-using adolescents. One of the approaches was implemented by all of the four geographically and institutionally diverse treatment facilities collaborating in CYT; each of the other four approaches was implemented in two of the sites. Using the Drug Abuse Treatment Cost Analysis Program (DATCAP), the economic cost of each site-specific treatment was determined. The average economic costs of the five types of outpatient treatments ranged from $837 to $3334 per episode, and varied by both direct factors (e.g. hours of treatment, treatment retention) and indirect factors (e.g. cost of living, staff level, case-load variation). These adolescent treatment cost estimates are examined in terms of their calculation, variability by condition, variability by site within condition and comparability with previous DATCAP results from outpatient drug-free programs for adults. Future research will integrate treatment outcomes and costs to complete cost-effectiveness and benefit-cost analyses of the five therapies.

Benefit-cost analysis of addiction treatment: methodological guidelines and empirical application using the DATCAP and ASI.

To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment. A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines. Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates. The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission. The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se. This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment.

Using the DATCAP and ASI to estimate the costs and benefits of residential addiction treatment in the State of Washington

Funding agencies and policy makers often criticize residential addiction treatment because the cost of residential services is typically higher than for outpatient services and it is unclear whether the outcomes are significantly better for most clients. To address these concerns, proponents of residential treatment require economic evidence to justify further investments in this modality over less intensive and less costly options. Recent studies have developed methods and empirical guidelines for using the drug abuse treatment cost analysis program (DATCAP) and the addiction severity index (ASI) in a comprehensive economic evaluation of addiction treatment. The present study applied these methods and guidelines to estimate the economic costs and benefits of residential addiction treatment at five programs in the State of Washington, USA that serve publicly funded clients. Program- and client-specific economic cost estimates were derived using data collected on-site with the DATCAP along with opportunity cost estimates associated with treatment attendance. Economic benefits were calculated from client self-reported information at treatment entry and at 6 months post discharge using the ASI. Outcome categories included inpatient services, employment, medical and psychiatric conditions, and criminal activity. Results indicate that average weekly economic cost of treatment services at the five programs ranged from $463 to $703. Average (per client) economic cost of treatment was $4912 (composed of $3650 in program cost and $1262 in client cost) for all subjects that completed both a baseline and follow-up questionnaire ( N=222; 82%). Average (per client) total economic benefit was $21,329, leading to estimates of $16,418 for average net benefit and 4.34 for the benefit–cost ratio. Total and net economic benefits were significantly related to gender, race, religious preference, and baseline ASI composite scores for drug use and legal status. A detailed sensitivity analysis did not alter the qualitative findings. This study provides conclusive evidence that, for this sample of programs in Washington State, the economic benefits of residential addiction treatment significantly exceeded the economic costs. Although the results are not necessarily generalizable to private-paying clients or clients from other States in the US, the methods are based on widely used data collection instruments and well-accepted economic principles. Thus, extensions of this research to other clients, States, and modalities should be feasible and straightforward.

Estimating the economic cost of substance abuse treatment.

Few studies have estimated the economic costs and benefits of substance abuse treatment services. This paper introduces a data collection instrument and method for estimating the economic cost of substance abuse treatment programs. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is based on standard economic principles and the method has recently been tested in two drug abuse intervention studies. Findings from case studies at three treatment programmes are presented to demonstrate the feasibility and reliability of the instrument. The estimation methods and results can be used by treatment programmes for self-evaluation purposes and by researchers who are interested in performing cost-effectiveness or benefit-cost analyses of substance abuse services.

A structured instrument for estimating the economic cost of drug abuse treatment

Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. Furthermore, not all cost methods are consistent, which can lead to noncomparable estimates that are difficult to use for policy or planning purposes. Our paper tries to fill this gap in the research literature and provide treatment programs with a much-needed technical assistance tool. Specifically, we present a structured and scientifically-based instrument for estimating the economic cost of treatment services. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is described in detail along with a companion instrument to analyze treatment financing; the Drug Abuse Treatment Financing Analysis Program (DATFin). The components of both instruments are outlined and findings from a variety of actual case studies are presented. Lastly, we discuss the DATCAP User's Manual, which will enable individual programs to begin collecting the necessary data and estimating economic costs at their own clinics.