Understanding the Societal Value of the Health Improvements Associated with Providing Medication Assisted Treatment in a Large Urban Jail

项目摘要 美国犯罪的经济负担远远超过任何其他西化国家和地区 这些成本中有很大一部分与累犯有关。临床证据表明，药物治疗 针对监狱人群的辅助治疗(MAT)可以有效地减轻药物滥用。然而， 这些计划没有被大规模采用，部分原因是缺乏关于 这些项目的经济影响。这项拟议研究的目标是更好地理解 MAT对被监禁人群的影响，并改进和进一步发展用于 评估这些类型的计划。为了做到这一点，我们将利用一种新的美沙酮维护数据 在西南部一所大型城市监狱实施的治疗(MMT)计划。我们的分析将建立在之前的 项目评估发现，在阿片依赖囚犯中继续进行MMT与 再次监禁的可能性大大降低。这项经济研究有三个目的。首先，我们将估计 使用药物滥用治疗成本分析计划(DATCAP)在监狱实施MAT的成本，a 被广泛采用的方法，已被用于计算100多种药物滥用的经济成本 治疗方案。其次，我们将使用这些成本估算并结合来自多个国家的详细数据 新墨西哥州监狱和法院的数据集，以评估这一计划的成本效益。最后，我们的第三个目标 是从社会的角度使用多变量犯罪成本来评估这一计划的影响 接近。值得注意的是，虽然这种类型的方法提供了一种高效且廉价的经济方式 使用管理数据评估项目，它很少被利用。这可能是由于一些 使用货币化犯罪结果变量的方法和统计挑战(例如，缺乏变异性， 质量点为零和偏斜度)。作为这一目标的一部分，我们将使用一个数字来解决这些统计问题 完善的统计方法(例如，记录、调整和审查技术)和更先进的方法 经验方法(两阶段模型、Box-Cox变换和范畴模型)。这些改进 统计模型将导致更多和更有效地使用犯罪成本模型，而犯罪成本模型又将增加 向政策制定者提供的有关药物滥用干预益处的信息质量 程序。

Project Summary The economic burden of crime in the United States far exceeds that of any other westernized country and a large proportion of these costs are associated with recidivism. Clinical evidence suggests that medication assisted treatment (MAT) for jail-based populations can be effective in mitigating substance abuse. However, these programs have not been adopted on a large scale, in part due to a lack of information about the economic implications of these programs. The goal of this proposed study is to better understand the economic impact of MAT in incarcerated populations and to improve and further develop empirical techniques used to evaluate these types of programs. To do this, we will utilize data from a novel methadone maintenance treatment (MMT) program implemented in a large urban jail in the Southwest. Our analysis will build on a prior program evaluation that found the continuation of MMT among opiate dependent inmates was associated with a significantly lower probability of re-incarceration. This economic study has three aims. First, we will estimate the costs of implementing MAT in jails using the Drug Abuse Treatment Cost Analysis Program (DATCAP), a widely adopted method that has been used to calculate the economic costs of over 100 substance abuse treatment programs. Second, we will use these cost estimates in combination with detailed data from a number of New Mexico jail and court datasets to estimate the cost-effectiveness of this program. Finally, our third aim is to estimate the impact of this program from a societal perspective using a multivariate cost-of-crime approach. Notably, while this type of approach provides an efficient and inexpensive way to economically evaluate programs using administrative data, it has been utilized rarely. This is likely due to a number of methodological and statistical challenges of using monetized crime outcome variables (e.g. lack of variation, mass points at zero and skewness). As part of this aim we will address these statistical issues using a number of well-established statistical methods (e.g., logging, trimming and censoring techniques) and more advanced empirical techniques (two-stage models, Box-Cox transformations and categorical models). These improved statistical models will lead to greater and more effective use of cost-of-crime models, which in turn will increase the quality of information provided to policy makers about the benefits of substance abuse intervention programs.