Benefit-cost in the California treatment outcome project: Does substance abuse treatment "pay for itself"?
Benefit-cost in the California treatment outcome project: Does substance abuse treatment "pay for itself"?
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DOI：
10.1111/j.1475-6773.2005.00466.x
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发表时间：
2006-02-01
影响因子：
3.4
通讯作者：
Hser, YI
中科院分区：
文献类型：
--
作者：
Ettner, SL;Huang, D;Hser, YI
Objective.检查与药物滥用治疗相关的成本和货币收益。数据来源。2000- 2001年期间加州13个县43个药物滥用治疗提供者的客户结果和代理成本的主要和管理数据。研究设计。使用社会规划师的角度来看，估计的治疗直接成本与相关的货币利益，包括客户的医疗保健，心理健康服务，犯罪活动，收入和（从政府的角度来看）转移计划支付的成本进行了比较。客户的药物滥用治疗事件的成本估计的天数，客户在每一个治疗模式的估计平均每日费用乘以该模式。使用治疗前后入院研究设计，即，每个客户端都作为自己的控制。数据收集。使用药物滥用治疗成本分析程序工具从提供者那里收集治疗成本数据。对于2，567名客户的主要样本，从基线和9个月的随访访谈中获得了关于医疗住院，急诊室就诊，收入和转移支付的信息，并与行政数据库中的住院和门诊精神卫生服务使用和犯罪活动信息相关联。敏感性分析检查了较大队列（N = 6，545）和较长时间段（1年）的管理数据结果。平均而言，药物滥用治疗的费用为1，583美元，与社会的货币收益11，487美元相关，收益与成本之比大于7：1。这些好处主要是因为犯罪成本降低和就业收入增加。即使不考虑改善健康和生活质量对客户的直接价值，将纳税人的钱用于药物滥用治疗可能是一项明智的投资。
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.