The past decade has witnessed a dramatic increase in treatment outcome studies compared to earlier periods. Despite the expansion in treatment outcome research, few studies have evaluated the economic merits of these programs. Recent methodological advances have led to a comprehensive and consistent approach for estimating treatment costs (French, et al., 1995; Dunlap and French, 1995; French, et.al., 1994; Bradley, French, and Rachal, 1994), and a few studies have used these methods to compare the costs and outcomes of treatment (Harwood et al., 1988; French and Zarkin, 1992; Tabbush, 1986; Anglin, et al., 1989). But, we are not aware of any study that has conducted a rigorous cost, or cost-effectiveness analysis of """"""""real world"""""""" drug abuse treatment across a variety of programs. The proposed study represents a collaboration among the Research Triangle Institute (RTI), the Penn Instrument and Methods Development Center (IMDC) and the Treatment Research Institute (TRI) at University of Pennsylvania to accomplish the following objectives. First, we will administer our recently-developed treatment cost and treatment financing instruments at a purposive sample of 24 programs that are being evaluated by the TRI. The cost data will allow us to compute the total annual cost and average (per client) annual cost of treatment services in different modalities and settings. The financing data will provide comparative information on funding sources and amounts, managed care practices, and concerns about health care reform proposals, Both instruments will be rigorously tested for reliability and validity. Second, at each program we will estimate intake and follow-up values for outcome criteria in six categories--HIV/AIDS risk reduction, substance use, criminal activity, physical and psychological health status, family conflicts, and employment. The outcome variables will be derived from the Addiction Severity Index (ASI) which we will administer to approximately 100 clients at each of these 24 programs. Third, we will perform a cost-effectiveness analysis using results from the cost and outcome studies. The cost-effectiveness ratios will be calculated for a number of different outcomes, and these ratios can be compared across programs and client subgroups for any particular outcome. There will be three important results from this project. First, the proposed reliability and validity testing across the various programs will help to establish the parametric limits of these cost measurement methods across a range of real programs. Second, these cost data, in combination with the standardized outcome information will be among the first comprehensive and consistent information on the economic costs of drug abuse treatment performed in """"""""real world"""""""" settings. Lastly, the findings may be useful to government agencies and public and private treatment providers allocate resources to the most cost- effective treatment alternatives.
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