Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from a national prospective cohort survey.
OBJECTIVE
To assess the incremental cost-effectiveness of drug addiction treatment programmes provided in the UK by the National Health Service and not-for-profit agencies in terms of crime-related outcomes. All costs and crime-related outcomes were implicitly evaluated relative to a 'no treatment' alternative.


METHODS
Longitudinal observational data on a national sample of heroin addicts referred to addiction treatment services throughout England were re-analysed. Predictions from a Poisson random-effects model were used to estimate the incremental effectiveness and cost-effectiveness of treatment programmes. Interaction variables were used to assess whether the injecting of heroin on entry to treatment had an impact on cost-effectiveness.


RESULTS
The findings rejected the null hypothesis that increasing time in treatment (and therefore treatment cost) has no mean crime prevention effect on clients referred for community-based methadone treatment, treatment delivered within specialist drug dependency units and residential rehabilitation programmes (P < 0.05). However, the size of the cost per unit of effect based on model predictions was sensitive to the exclusion of a small group of outlying observations. The interaction between client injecting status and time in treatment was found to be statistically significant (P < 0.05), with an estimated reduction in treatment cost-effectiveness across all treatment programmes for clients who reported injecting drugs at treatment intake.


CONCLUSIONS
Whilst the analyses did not include an evaluation of the effect of treatment programmes on client health and quality of life and stopped short of providing a social weighting for the predicted reduction in crimes, they do offer a useful starting point for establishing the cost-effectiveness of treating heroin addiction. The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services.
Healey
Andrew
A
LSE Health and Social Care and PSSRU, London School of Economics and Political Science, London, UK.
Knapp
Martin
M
Marsden
John
J
Gossop
Michael
M
Stewart
Duncan
D
D003362:Cost-Benefit Analysis; D003415:Crime / Q000145:classification / Q000517:prevention & control / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006556:Heroin Dependence / Q000191:economics* / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008691:Methadone / Q000008:administration & dosage; D017059:Models, Econometric; D015999:Multivariate Analysis; D009939:Organizations, Nonprofit; D017063:Outcome Assessment, Health Care / Q000379:methods; D016012:Poisson Distribution; D013222:State Medicine; D016320:Substance Abuse Treatment Centers / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000534:rehabilitation / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology
D008691:Methadone