Abstract
Economic evaluation of substance abuse interventions plays a critical role in informing stakeholders and decision-makers involved in funding these programs. In particular, there are increasing demands to justify the expenditures on new and more effective interventions using economic evidence, facilitating the allocation of scarce resources more efficiently. This chapter presents a brief introduction and overview of the major methods used in economic evaluation for substance abuse treatment and prevention programs, including cost-of-illness analyses, cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses. The importance of context with regard to economic evaluation is also discussed. Details are presented for each method, including an overview of key advantages and disadvantages for each. Case-based examples specific to substance abuse treatment and prevention are also provided to illustrate the application of these methods in applied settings. Finally, comparisons are made between the different methodologies to illustrate how each provides important insights to decision-makers charged with making important decisions regarding the allocation of funds in support of interventions to prevent or treat substance abuse.
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Notes
- 1.
Following their systematic review of methodologies used in cost-of-illness studies in the United States, Clabaugh and Ward (2008) urged caution when interpreting or applying results, until such time that accepted standards for the execution COI studies were adopted.
- 2.
While a detailed discussion of the human capital approach is beyond the scope of this chapter, there are a number of issues with the estimates derived. Most notably, because it relies on existing earnings patterns, greater weight is given to working-aged men compared to other demographic groups.
- 3.
Examples of costs include nonmonetary costs, such as emotional distress and productivity losses associated with the illness, premature death, and crime associated with drug use. Equally important are the treatment costs associated with the many medical complications associated with abuse, estimated to amount to US$8.4 billion (Cartwright 2008).
- 4.
For example, estimates for counseling depend on the nature of the patient, as well as the type of treatment program under consideration. In one residential program, cost of an hour of an hour of counseling was about two-thirds less for long-stay patients compared to short-stay patients (Alemi et al. 2002).
- 5.
The same can be said of any effort to prioritize based on a single criterion (Baltussen and Niessen 2006). The reality is that the situations are often far more complex. Therefore, priority setting efforts must take into account multiple criteria simultaneously to be effective.
- 6.
While alcoholism treatment does not have a commonly accepted standard of effect, in many situations, the intended treatment goal is abstinence. However, when measuring abstinence, the necessary length of time a subject abstains from using alcohol to qualify is debated.
- 7.
Costs differences across setting were due, in part, to the different staffing requirements associated with each.
- 8.
It should be noted that insufficient evidence is not equivalent to “not effective” in this case. More evidence is needed before the higher expenditures could be sufficiently justified.
- 9.
For more information on how health-related quality of life is measured in public health practice, see Hennessy et al. (1994).
- 10.
For more information on the CPI, visit the Bureau of Labor Statistics web site http://www.bls.gov/cpi/.
- 11.
See Hansson (2007) for a comprehensive review of the philosophical problems associated with cost-benefit analysis.
- 12.
For additional information, see www.samhsa.gov/sbrit/about.
- 13.
SBIRT has been previously demonstrated to have cost-benefit from a societal perspective (Fleming et al. 2002). In this analysis, the authors wanted to answer from an employer’s perspective: Should employers be willing to pay for SBIRT services?
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Oglesby, W.H., Birmingham, L. (2017). Economic Evaluation of Substance Abuse and Prevention Programs. In: VanGeest, J., Johnson, T., Alemagno, S. (eds) Research Methods in the Study of Substance Abuse. Springer, Cham. https://doi.org/10.1007/978-3-319-55980-3_19
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