Societal & Patient Utilities for Drug Problems

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DESCRIPTION (provided by applicant): Cost-utility analysis (CUA), a type of economic evaluation in which health effects are measured in the metric of Quality-Adjusted Life-Years (QALYs), is a valuable tool for assessing the relative efficiency of health care programs. However, the application of CUA to drug abuse treatment programs is limited by the absence of societal and patient preference-based utility weights for drug-related health states and consequences, which are needed to calculate QALYs. The main goal of this proposal is to advance the application of CUA to drug abuse program evaluation by achieving 2 specific aims: 1). Develop methods for the direct measurement of utility weights for a spectrum of drug-related health states and consequences; and 2) Test and compare the test-retest reliability, consistency, and discrimination of the direct utility measurement methods in three key "stakeholder" groups: persons with drug abuse, significant others of persons with drug abuse, and the general population. To accomplish these aims, we will use focus groups of stakeholders and a panel of researchers/clinicians to define, develop, and validate health state descriptions for a spectrum of drug-related conditions and consequences. Fifty drug abusers in treatment, 50 significant others of drug abusers, and 50 subjects from the general population will assign utility weights to the drug-related health states using established utility measures (Time Trade-Off and Standard Gamble). Although the main focus of this project is the development and testing of the methods, we will test exploratory hypotheses that: 1) utility ratings decrease as the severity of the drug-related health states increase; and 2) utility ratings for specific drug-related related health states will differ significantly among the three stakeholder groups. The results of this project will be used for QALY calculation in future CUA of drug abuse treatment programs. In addition, the focus group and panel process for developing the drug-related health state descriptions will yield important insights into differences in preferences/values among the stakeholder groups and will guide future research.