Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 19--Cost effectiveness
Chapter 19--Cost effectiveness
Pages 455-463
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From page 455... ...
, if it does so to such an extent that the value of the cost savings more than offsets the cost of the treatment, and if the treatment at least does no harm, then it might legitimately be said that the treatment is Cost effective and obviously desirable in the sense that it leads to negative net medical costs compared with a No treatments alternative. The cost-effectiveness analysis of treatment for alcohol problems has, to a considerable extent, pursued this question of cost offset (IOM, 1989~.
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From page 456... ...
These studies failed to find a cost offset and may in fact have found a cost increase. This finding is in contrast to those from earlier studies of public clients (JWK International Corporation, 1976; Gregory et al., 1982; Becker and Sanders, 1984~; however, those studies projected substantial cost offsets but were not based on actual total expense data.
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From page 457... ...
Thus, the overall picture regarding cost offsets is one of cost declines after treatment for people who are not poor, declines which are frequently large enough to offset the cost of treatment (Luckey, 1987~. Do these studies conclusively demonstrate that there is a negative net cost?
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From page 458... ...
Nevertheless, these results raise serious questions about the inevitability of cost offsets from more extensive insurance coverage, and they surely do not prove that better coverage saves enough money to offset its cost. It would be possible to reproduce these studies, even in private insurance settings, by phasing in more generous benefits for treatment of alcohol problems on a random or nonsystematic basis.
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From page 459... ...
Moreover, even if it should have a positive net cost, that cost is likely to be low enough that the benefit provided by such interventions would usually be judged to be worth the cost.) Beyond brief interventions, however, there is simply no basis for determining the additional costs compared with the additional benefits because there is much uncertainty about benefits and virtually complete ignorance about costs.
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From page 460... ...
There was one random assignment study where residential care proved more effective for socially disadvantaged persons (Wanberg, Horn, and Fairchild, 1974~. Against these exceptions, however, is mounted a group of studies that show that outpatient or day treatment settings offer effective treatment that is at least as good as-if not better than that offered in inpatient/residential settings.
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From page 461... ...
Defensible measures of the cost-effectiveness of treatment beyond brief interventions for particular populations are simply not available; consequently, the data on cost-effectiveness are still insufficient for unambiguous policy guidance. Accordingly, the committee sees it
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From page 462... ...
In particular, studies should be undertaken to determine the question of whether it is necessary to provide discrete coverage for brief interventions in order to bring more persons into treatment and to compare alternative detoxification and primary rehabilitation strategies. As recommended in Chapter 18, there should also be an expansion of the federal government's services research effort to establish the cost-effectiveness of alternative strategies and models for treating alcohol problems.
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From page 463... ...
1986. Alcoholism treatment and total health care utilization and costs: A four year longitudinal analysis of federal employees.
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