Benefit-cost in the California treatment outcome project: does substance abuse treatment "pay for itself"?
OBJECTIVE
To examine costs and monetary benefits associated with substance abuse treatment.


METHODS
Primary and administrative data on client outcomes and agency costs from 43 substance abuse treatment providers in 13 counties in California during 2000-2001.


METHODS
Using a social planner perspective, the estimated direct cost of treatment was compared with the associated monetary benefits, including the client's costs of medical care, mental health services, criminal activity, earnings, and (from the government's perspective) transfer program payments. The cost of the client's substance abuse treatment episode was estimated by multiplying the number of days that the client spent in each treatment modality by the estimated average per diem cost of that modality. Monetary benefits associated with treatment were estimated using a pre-posttreatment admission study design, i.e., each client served as his or her own control.


METHODS
Treatment cost data were collected from providers using the Drug Abuse Treatment Cost Analysis Program instrument. For the main sample of 2,567 clients, information on medical hospitalizations, emergency room visits, earnings, and transfer payments was obtained from baseline and 9-month follow-up interviews, and linked to information on inpatient and outpatient mental health services use and criminal activity from administrative databases. Sensitivity analyses examined administrative data outcomes for a larger cohort (N=6,545) and longer time period (1 year).


RESULTS
On average, substance abuse treatment costs $1,583 and is associated with a monetary benefit to society of $11,487, representing a greater than 7:1 ratio of benefits to costs. These benefits were primarily because of reduced costs of crime and increased employment earnings.


CONCLUSIONS
Even without considering the direct value to clients of improved health and quality of life, allocating taxpayer dollars to substance abuse treatment may be a wise investment.
Ettner
Susan L
SL
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1736, USA.
Huang
David
D
Evans
Elizabeth
E
Ash
Danielle Rose
DR
Hardy
Mary
M
Jourabchi
Mickel
M
Hser
Yih-Ing
YI
D002140:California; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods; D017598:Efficiency, Organizational / Q000191:economics; D017050:Episode of Care; D006801:Humans; D016320:Substance Abuse Treatment Centers / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome