Abstract
Objective: To estimate the benefits of reduced cocaine consumption in terms of reduced societal costs resulting from the introduction of a medication for cocaine dependence with a small incremental treatment effect.
Study design: Cost-benefit analysis is applied to study the implications of reduced cocaine consumption. A modelling approach extrapolates the magnitude of treatment effects.
Methods: Epidemiological data on cocaine use and consumption as well as economic methods of cost-benefit analysis are utilised. Estimates of societal costs associated with heavy users of cocaine, who are most likely addicted and in need of immediate treatment, are developed using 1995 data.
Main outcome measures and results: In the first analysis, a postulated 1% reduction in consumption of cocaine among heavy users is examined to approximate a small treatment effect, resulting in a minimal consumption benefit. It is estimated that such a reduction would be valued at $US259 million. The cost-benefit analysis indicated that a cocaine medication with a small treatment effect (10 percentage point increase in abstinence rates) would result in a benefit to cost ratio in the range of 1.58 to 5.79, depending on prescribing behaviour and type of patient.
Conclusions: Such estimates of the benefits of these small treatment effects are conservative, and they may be biased downwards since the willingness to pay for such a cocaine medication could far exceed the benefit to cost estimation used in this paper. Nevertheless, the substantial benefits found in this paper indicate how important investment in cocaine medication is for public health policy; costs may be reduced with efficient prescribing behaviour. Market and governmental barriers to the utilisation of a cocaine medication could reduce the benefits and increase costs. Clinical trials, cost-effectiveness studies, and cost-benefit studies must be conducted to establish the actual pattern of benefits and costs that could be obtained for an efficacious and effective cocaine medication.
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References
Harwood H, Fountain D, Livermore G, and The Lewin Group. The economic costs of alcohol and drug abuse in the United States, 1992. NIH publication no. 98–4327. Rockville (MD): National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998: 1–10 [online]. Available from: URL: www.165.112.78.61 [Accessed 2000 Aug 16]
Carroll KM. Manual 1, a cognitive-behavioral approach: treating cocaine addiction. NIH publication no. 98–4308. Bethesda (MD):National Institute on Drug Abuse, 1998 [online].Available from: URL: http://www.nida.nih.gov/txmanuals/cbt/cbt1.html [Accessed 2000 Aug 16]
Rydell SP, Everingham SS. Controlling cocaine, supply versus demand programs. Report to the Office of National Drug Control Policy. Santa Monica (CA): RAND Corporation, 1994
Rhodes W. Synthetic estimation applied to the prevalence of drug use. J Drug Issues 1993; 23 (2): 297–321
Rhodes W. What America’ users spend on illegal drugs, 1988–1993.Washington, DC: Office of National Drug Control Policy, 1995
US Congress, Senate Committee on the Judiciary. Hard-core cocaine addicts: measuring-and-fighting-the epidemic. A staff report for the use of the committee on the judiciary, 1990. US Congress, 1990
Homer J. A system dynamics model for cocaine prevalence estimation and trend projection. J Drug Issues 1993; 23 (2): 251–79
Everingham SC, Rydell CP. Modeling the demand for cocaine. Santa Monica (CA): RAND Corporation, 1994
Office of National Drug Control Policy. The National Drug Control Strategy. Washington, DC: Government Printing Office, 1997: 10–1
Office of National Drug Policy. The National Drug Control Policy Strategy. Washington, DC: Government Printing Office, 1998
Hubbard RL, Craddock SG, Flynn PM, et al. Overview of 1- Year Follow-up Outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997; 11 (4): 261–78
Alterman AI, O’Brien CP, McLellan AT, et al. Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation. J Mental Nervous Dis 1994; 182 (3): 157–63
O’Brien CP, McLellan AT. 1996. Myths about the treatment of addiction. Lancet 1996; 347: 237–40
Office of Applied Studies. Uniform Facility Data Set (UFDS): data for 1996 and 1980–1996. DHHS publication no (SMA) 98–3176.Washington,DC: Substance Abuse and Mental Health Administration, 1996: 52
Office of Applied Studies. National admissions to substance abuse treatment services. The Treatment Episode Data Set (TEDS) 1992–1996. DHHS publication no. (SMA) 98–3244. Rockville (MD): Substance Abuse and Mental Health Administration, 1998: 52
Cohen J. Statistical power analysis for the behavioral sciences. New York (NY): Academic Press, 1977
Hannan T. The benefits and costs of methadone maintenance. Public Policy 1976; 24 (2): 197–226
National Institutes of Health. NIH Consensus panel recommends expanding access to and improving methadone treatment programs for heroin addiction [press release]. Rockville (MD): NIH, 1997 Nov 17 [online]. Available from: URL: http://www.nih.gov/news/pr/nov97/od-19.htm [Accessed 2000 Aug 16]
Acknowledgements
The author appreciates the helpful comments of Paul Solano, Michael French, Donald Shepard, Jody Sindelar, Robert Battjes, Stephen Zukin, Bennett Fletcher, Frank Vocci, Andrea Baruchin, Joel Egertson, Jerry Flanzer, Carol Cowell and two anonymous referees on an early draft of this paper. I am responsible for all errors.
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Cartwright, W.S. Cocaine Medications, Cocaine Consumption and Societal Costs. Pharmacoeconomics 18, 405–413 (2000). https://doi.org/10.2165/00019053-200018040-00008
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DOI: https://doi.org/10.2165/00019053-200018040-00008