PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 1997 December; 32(5): 615–629.
PMCID: PMC1070218

Cost-effectiveness of inpatient substance abuse treatment.

Abstract

OBJECTIVE: To identify the characteristics of cost-effective inpatient substance abuse treatment programs. DATA SOURCES/STUDY SETTING: A survey of program directors and cost and discharge data for study of 38,863 patients treated in 98 Veterans Affairs treatment programs. STUDY DESIGN: We used random-effects regression to find the effect of program and patient characteristics on cost and readmission rates. A treatment was defined as successful if the patient was not readmitted for psychiatric or substance abuse care within six months. PRINCIPAL FINDINGS: Treatment was more expensive when the program was smaller, or had a longer intended length of stay (LOS) or a higher ratio of staff to patients. Readmission was less likely when the program was smaller or had longer intended LOS; the staff to patient ratio had no significant effect. The average treatment cost $3,754 with a 75.0% chance of being effective, a cost-effectiveness ratio of $5,007 per treatment success. A 28-day treatment program was $860 more costly and 3.3% more effective than a 21-day program, an incremental cost-effectiveness of $26,450 per treatment success. Patient characteristics did not affect readmission rates in the same way they affected costs. Patients with a history of prior treatment were more likely to be readmitted but their subsequent stays were less costly. CONCLUSIONS: A 21-day limit on intended LOS would increase the cost-effectiveness of treatment programs. Consolidation of small programs would reduce cost, but would also reduce access to treatment. Reduction of the staff to patient ratio would increase the cost-effectiveness of the most intensively staffed programs.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bleiberg JL, Devlin P, Croan J, Briscoe R. Relationship between treatment length and outcome in a therapeutic community. Int J Addict. 1994 Apr;29(6):729–740. [PubMed]
  • Finney JW, Monahan SC. The cost-effectiveness of treatment for alcoholism: a second approximation. J Stud Alcohol. 1996 May;57(3):229–243. [PubMed]
  • Friedman AS, Glickman NW. Residential program characteristics for completion of treatment by adolescent drug abusers. J Nerv Ment Dis. 1987 Jul;175(7):419–424. [PubMed]
  • Gfroerer JC, Adams EH, Moien M. Drug abuse discharges from non-federal short-stay hospitals. Am J Public Health. 1988 Dec;78(12):1559–1562. [PubMed]
  • Holder H, Longabaugh R, Miller WR, Rubonis AV. The cost effectiveness of treatment for alcoholism: a first approximation. J Stud Alcohol. 1991 Nov;52(6):517–540. [PubMed]
  • Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics. 1982 Dec;38(4):963–974. [PubMed]
  • Mattick RP, Jarvis T. In-patient setting and long duration for the treatment of alcohol dependence? Out-patient care is as good. Drug Alcohol Rev. 1994;13(2):127–135. [PubMed]
  • McCusker J, Vickers-Lahti M, Stoddard A, Hindin R, Bigelow C, Zorn M, Garfield F, Frost R, Love C, Lewis B. The effectiveness of alternative planned durations of residential drug abuse treatment. Am J Public Health. 1995 Oct;85(10):1426–1429. [PubMed]
  • Mechanic D, Schlesinger M, McAlpine DD. Management of mental health and substance abuse services: state of the art and early results. Milbank Q. 1995;73(1):19–55. [PubMed]
  • Moos RH, Pettit B, Gruber V. Longer episodes of community residential care reduce substance abuse patients' readmission rates. J Stud Alcohol. 1995 Jul;56(4):433–443. [PubMed]
  • Peterson KA, Swindle RW, Phibbs CS, Recine B, Moos RH. Determinants of readmission following inpatient substance abuse treatment: a national study of VA programs. Med Care. 1994 Jun;32(6):535–550. [PubMed]
  • Phibbs CS, Swindle RW, Recine B. Does case mix matter for substance abuse treatment? A comparison of observed and case mix-adjusted readmission rates for inpatient substance abuse treatment in the Department of Veterans Affairs. Health Serv Res. 1997 Feb;31(6):755–771. [PMC free article] [PubMed]
  • Stinson DJ, Smith WG, Amidjaya I, Kaplan JM. Systems of care and treatment outcomes for alcoholic patients. Arch Gen Psychiatry. 1979 May;36(5):535–539. [PubMed]
  • Swindle RW, Jr, Beattie MC, Barnett PG. The quality of cost data. A caution from the Department of Veterans Affairs experience. Med Care. 1996 Mar;34(3 Suppl):MS83–MS90. [PubMed]
  • Weisner C, Greenfield T, Room R. Trends in the treatment of alcohol problems in the US general population, 1979 through 1990. Am J Public Health. 1995 Jan;85(1):55–60. [PubMed]
  • Welte J, Hynes G, Sokolow L, Lyons JP. Effect of length of stay in inpatient alcoholism treatment on outcome. J Stud Alcohol. 1981 May;42(5):483–491. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust