Wednesday, October 22, 2008

Cost Benefit Analysis of Substance Abuse Treatment



The Journal of Mental Health Policy and Analysis published an article in 1998 entitled, "Cost Benefits of Substance Abuse Treatment: An Overview of Results from Alcohol and Drug Abuse. This study is a review of results from several studies which examines the cost benefits that were experienced, or not experienced, in health care settings after the inclusion of substance abuse treatment services. Review the article, and critically comment on the results, the method of evaluation, and the author's comments on both.

33 comments:

Stu J. said...

I appreciate and respect th work done by Holder in the referenced article. I particularly appreciated the referenced study by the author and Hallan based on their work with the California Public Employees Retirement System.

The article presents complex information and findings in an easy to understand format.

Anonymous said...

After reviewing the abstract, I would have expected the results that treatment results in lower health care cost. As such, treatment should be made more availabe to patients. I am aware of family member who had BC/BS and as such was admitted to North Harber, because the treatmetn was for alcohol addictions, the insurance did not cover the hospitalization. It is important to bring attention to lapses in care, and I beleive that in patient treatment for substance abusers should be covered to lesson the burden related to other medical conditions.

V Holloway, Tuscaloosa

STACY C. said...

One thing this article pointed out to me is the many different ways in which research can be conducted to support the same hypothesis. Some of the research provided in the beginning of the article was a bit outdated and alcoholics/drug abusers and treatment carry different attitudes about recovery and the process and therefore health care provisions are different as well as attitudes toward health care and seeking health care are also different they are in todays society. I liked how it pointed out that the validity of such research is questionable because control groups are not used in some studies and studying non-treated alcoholics is not very likely due to the likelihood of participation and other related factors of active alcoholics and addicts (I don't necessarily think that just because a control group of active users is not used in the study constitutes invalidity). It is sort of common sense to me that post-treatment health care cost would decline as well as the fact that younger alcoholics/addicts in recovery will also have less health care costs.
STACY C.

Taylor said...

It is interesting to see an article about the costs/benefits of substance abuse treatment. I am glad they found treatment to be “cost effective”, but I personally feel like it is somewhat unethical to measure treatment’s usefulness based on future health cost. In my opinion, it would be more ethical to measure rates of relapses and/or levels of sobriety post treatment.

Stu J. said...

In response to Taylor's post, I appreciate and respect your comment regarding the importance of measuring sobriety and relapse, I do also recognize the validity and value of considering health care costs in relation to expense incurred for a treatment program. It is one way to conduct such studies that funding sources can relate to well.

STACY C said...

I agree with Taylor that it is unethical to solely base the effectiveness of programs on cost evaluation; however, I did find this article interesting because they took that perspective. An evaluation approach like this must be a lot of work. STACY

Gina Smith said...

I was finally able to link to the abstract of this article. Though few studies have been done on the cost benefit of drug/alcohol treatment, I believe comman sense would support a positive correlation between drug/alcohol treatment and the decreased cost of health cost without treatment.
As this article is an evaluation of several studies, I found it interesting to note that they were all American studies. These studies compared the cost of health care prior to the beginning of treatment with the cost after beginning treatment. Perhaps more studies should be conducted and the findings used by insurance companies when deciding whether substance abuse treatment will be a covered item for their policy holders. It would stand to reason that if the cost benefit of treatment is that overall medical costs for the person is lowered over their lifetime, then it would be cost efficient for the insurance company to cover the cost of substance abuse treatment, at least once.

Gina Smith said...

Response: Taylor, I too think it appears unethical to measure the benefit of treatment on whether the treatment is cost effective. It is a sad sometimes, but in reality, in today's world, that is how most everything is measured. Am I getting the full bang for my buck? Substance abuse treatment would not be cost effective to insurance companies if they did not feel that they were going to come out, monetarily, on the positive end of the situation.

Teresa D. / Gadsden Center said...

This research should give the health insurance companies some incentive to provide for inpatient drug/alcohol treatment programs. As a Social Worker, when I read a study like this, I think not only of the cost benefits, but the family and social benefits. Good idea for research project.

Teresa D. / Gadsden Center said...

Response to stu j.
I agree about the ease of understanding the artical abstract. When we can understand what the research is about, we can make an informed decision as to it's benefit, or lack thereof to us.

ojwashington said...

This article was very interesting and informative. I agree that the treatment is cost effective. In my current position at the health department I have worked with many clients who have been a burden on our health care system through drug seeking behaviors. In many instances these clients have been taken to the hospital in an ambulance and provided treatment and in most cases prescribed medication. In most cases they are unable to pay for thier health care cost which caused most medical agencies to increase the price of their services provided to the public. Therefore it is more cost effective for those who have issues with drug seeking to receive treatment.

David L. said...

It was highly interesting to read the results and the actual cost benefits of alcohol and substance abuse. The article stated that there were many studies conducted to examine the cost benefit of alcohol treatment, but there were few studies done to examine the cost benefits of drug abuse treatment. Honestly, I think more studies should be done to compare the effectiveness and the cost benefit of alcohol/drug abuse program so potential future programs can have a solid model to learn from.

Anonymous said...

The Cost Benefit Analysis of Substance Abuse Treatment abstract clearly stated the cost benefits to treatment. I would be interested to know if this information had been communicated and disseminated in ways other then the article. I know that this is a highly studied area of interest but the results don’t appear to be getting across to the people it needs to reach. This is evidenced by insurance company’s hesitancy in paying for treatment. I thought the abstract ended on a high note by adding its suggestions for future generations to study the cost offset of specific treatments.
Heather M.

Anonymous said...

In response to V. Holloway, I too expected the cost benefit to be in favor of treatment. I think that there needs to be an intervention, so to speak, with the insurance company to express results of cost benefit analyses such as this. Unfortunately like so many other programs and resources, if it saves the government or insurance co. money they want no part of it. I work in hospice and there have been proven cost benefit analyses of hospice care programs yet it is not a widely accepted resource and many insurance co. do not pay for hospice care.
Heather M.

amyh-gadsden said...

In response to Stacy C. I also agree that this article was interesting in regard to the cost effectiveness approach that was taken.

amyh-gadsden said...

Treatment options should be made more readily available for those in need of services. I think the approach that was taken was interesting and informative. This is another example of the various types of research that can be conducted and used to help aid in making services better and more available.

Stacey L said...

The cost benefit of a substance abuse treatment makes logical sense to me. The use of drugs or alcohol can be responsible for multiple health problems to include high blood pressure, which can lead to stroke, heart disease, kidney damage, etc. Women seeking medical care over man is really something that I was not surprised in. I know personally with my own husband, he works swing shift and it is hard for him to get off of work and make it to his MD appt. If he is on night shift, he has been known to over sleep and then he misses the appointment. The results indicated that younger patients experience greater declines in medical care cost following alcoholism treatment initiation. I feel this could be due to the fact that you have provided the intervention to the young person before a lot of damage has occurred to the body. Where as an older patient has a longer history of substance abuse and damage has occurred and it is usually not reversible. As we get older we have more medical problems without the help of substance abuse damage to the body. Add your normal aging process to the damage of substance abuse and you are looking at a healthy price tag. I found this article to be very interesting since I work in home health care and we have patients that we are currently treating that the substance abuse has led them to their current medical condition. So trust me the cost is high for the damage that the substance abuse has caused. Stacey L.

Stacey L said...

In response to V. Holloway, it is worrisome that BCBS would not cover the stay for alcohol treatment. But you will find that most insurance companies will normally not cover “prevented treatment” and sometimes a patient might need the inpatient admission to get the start that they need to head down the road to recovery. That is like most insurance companies will not cover specialized air mattresses for a hospital bed for a patient to prevent skin break down which can lead to “bed sores”. The insurance companies will wait until the person has a really bad “bed sore” then they will give them the specialized mattress. We are talking about patients that are bed bound, they are not going to get out of bed, but just lay there, so why not try to head off the problem. Instead the insurance company will wait till the patient has a major problem (sore that is open all the way to the bone) before they will agree to pay for the mattress. Got one better than that, we have several patients that have specialized mattresses, if the “bed sore” starts to heal and show improvement, insurance companies as well as the medical supplier have been known to remove the mattress because it cost too much to have it in the home and the patient seems to be improving so therefore they are no longer in need. So nothing surprises me when it comes to insurance companies. Stacey L.

Anonymous said...

I agree with Stu, the article was complex and I could easily understand the findings. I highly appreciate when I can read and apply research to everyday pratice.

Taylor said...

I agree with teresa d. Health insurance companies should be impressed with this research. Hopefully, this article has impacted treatment decisions for Health Insurance companies

Sara S. said...

While I was reading this article I thought to myself “this totally makes sense”. Once people seek treatment for drugs or alcohol their overall health care cost should decrease. Drugs and alcohol affect every bodily system and can wreak havoc on user’s bodies, therefore causing possible irreversible damage to vital systems. One in particular that comes to mind is cirrhosis that eventually causes liver failure. The cost associated with treating someone with liver failure is astronomical, so if treatment for alcoholism is initialed before this stage then health care costs will decrease. This cost benefit analysis on drugs and alcohol was good and made sense to me. Of course inpatient treatment is probably more effective in the long run, but more costly. However, what if patients receive inpatient first then turn back to drugs or alcohol and end up having to seek inpatient care? Maybe it would be better to spend more money in the beginning with inpatient treatment. Working in the health care field I believe it makes more sense to spend money on prevention rather than treatment. It is more cost effective and seems to really work.

Sara Scarborough (Tuscaloosa)

Sara S. said...

In response to V Holloway,
I completely agree with what you said about lapses in care. Our healthcare system is really lacking in services, especially when it comes to any kind of mental health services or substance abuse treatment. There are just not enough treatment facilities available, and even when there are some available most people ant afford to seek treatment because their insurance will not cover it. I work at a clinic for patients that don’t have insurance and trying to find them any kind of substance abuse treatment is nearly impossible.

Sara S. (Tuscaloosa)

Tiffiney Brittingham said...

I found the article interesting. The treatment seems cost effective and should be made easily available to clients. However, when reading a study about alcohol or drug abuse it is always nice to know the recidivism rate. A study as complex and informative as this should have been able to provide that information.

Tiffiney Brittingham said...

I agree with Stu, the article was an easy and interesting read. I also agree with Taylor, it would be more ethical to measure rates of relapses and/or levels of sobriety post treatment.

Tysie Baker said...

The article on substance abuse was very interesting in that it seemed to measure the effects of costs before the initiation of substance abuse treatment. Apparently, the study showed that over time the monthly health case costs increased substantially 6-12 months before treatment, but after the initiation of treatment the costs went down. It seems to me that the costs would have increased during treatment and was incorrectly measured before treatment. I cannot fathom health care costs ever decreasing. It was also important for the study to point out that outpatient services were tremendously lower this would prove correct since the patient does not have to stay in the treatment facility. Overall, I believe the article provided some insight as to the cost of substance abuse treatment before and during treatment.

Tysie Baker said...

I must agree with Taylor. I was amazed that a study measured the costs before the treatment was ever completed. I am curious; would that be an ethical dilemma? Or could it have possibly started out as a logic model? I also believe it should have measured reoccurrence of substance abuse as well.

Anonymous said...

I really thought this research article only reiterated what we see everyday with our clients. It is just reasonable to expect a younger person who receives "effective substance abuse treatment" to bounce back from an illness and medical cost to decrese. And what I mean by effective is that they have adhered to the treatment received and are willing to adopt an attitude of abstinence when it comes to drug and alcohol abuse. It also stands to reason that an elderly person who has damaged his body over the years through drinking or drug use would have some chronic medical issues. The fact that women utilize medical care more than men was not a surprise either because most men with a stable work history just do not like to miss work for any reason and tend to put off seeing a doctor when they should. I know that the major insurances such as Bluecross pay for drug and alcohol treatment if the hospital or facility has this particular unit to address these issues. If decreased need for medical care is an indicator of effective treatment, and medical cost could decrease I surely dont think people should be penalized by denial of essential care.
C.Paulk

Anonymous said...

I agree with Stacie on her comments concerning the long term effects of alcohol use on an elderly person coupled with the natural aging process, and increased medical cost.

C. Paulk

Kristie R said...

This article was was really interesting especially since it was a cost benefit analysis of substance abuse treatment, however, i am a little surprised that treatment did not result in lower health care costs! The article also mentioned the lack of a control group which could potentially affect the validity of the study was also pointed out. The difficulty in using non-alcoholics in a control group for research purposes of this type would be very difficult for any study of this type.

LaTasha T. said...

I have a career interest in substance abuse. Therefore, this article was quite interesting to me. I think that it is important that substance abuse programs offer prevention services for individuals who have completed treatment so that they will not relapse.

I was not surprised that the amount of individuals who do not receive treatment have health costs at a greater rate than those who refuse to seek treatment. I have a friend who suffers from alcoholism, the effects have been detrimental on their body. Yet, they refuse to receive any form of treatment.

I agree that substance abuse treatment programs are beneficial in helping to cut down costs. I would like to see other topics that are completed on this topic.

Finally, there are several different treatment models that are used to treat substance abusers. I would like to see which treatments were used. There is the possibility that some of these models might have been more effective for younger people vs. older people and vice versa. .

LaTasha T. said...

This is response to OJ Washington:

I appreciate your comment on your professional experience. I think that it is so important that individuals who abuse substances seek treatment. And I believe that this treatment should be beneficial to them. Like you stated, when that person who abuses substances is not able to pay for their prescription, the public becomes responsible for making up that costs. I think the idea of seeking treatment needs to become more appealing so that individuals will not be afraid to seek treatment.

nikkig said...

In reviewing the abstract to this article, I found myself wondering about cost-benefits as they related to particular age groups receiving treatment for alcoholism and substance use. As was referenced in the conclusion, it is important to consider the implications for specific groups and their treatments as I suspect the cost benefits would vary for older clients receiving treatment.

nikkig said...

In respone to V. Holloway of Tuscaloosa, I agree with you with regard to the lapse in services. People seeking substance abuse treatment should have treatment covered under insurance which brings to light the significance of continuing research so that evidenced based interventions can be implemented. Though cost-benefit analyses have been completed, I still understand the significance of doing more specific research that would examine the variances among different age, gender, and racial groups.