Effectiveness and cost-effectiveness of four treatment modalities for substance disorders: a propensity score analysis.
OBJECTIVE
To assess the effectiveness and cost-effectiveness of four treatment modalities for substance abuse.


METHODS
The study used data from the Services Research Outcomes Study (SROS), a survey of 3,047 clients in a random sample of 99 drug treatment facilities across the United States. Detailed sociodemographic, substance use, and clinical data were abstracted from treatment records. Substance abuse outcome and treatment history following discharge from index facilities were assessed using a comprehensive interview with 1,799 of these individuals five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use.


METHODS
Effectiveness and cost-effectiveness of four modalities were compared: inpatient, residential, outpatient detox/methadone, and outpatient drug-free. Clients were stratified based on propensity scores and analyses were conducted within these strata. Sensitivity analyses examined the impact of future substance abuse treatment on effectiveness and cost-effectiveness estimates.


RESULTS
Treatment of substance disorders appears to be cost-effective compared to other health interventions. The cost per successfully treated abstinent case in the least costly modality, the outpatient drug-free programs, was 6,300 dollars (95 percent confidence intervals: 5,200-7,900 dollars) in 1990 dollars. There were only minor differences between various modalities of treatment with regard to effectiveness. However, modalities varied considerably with regard to cost-effectiveness. Outpatient drug-free programs were the most cost-effective. There was little evidence that relative effectiveness or cost-effectiveness of programs varied according to factors that were associated with selection into different programs.


CONCLUSIONS
Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment.
Mojtabai
Ramin
R
Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, USA.
Zivin
Joshua Graff
JG
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D016320:Substance Abuse Treatment Centers / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States