Methodological Considerations in Social Cost Studies of Addictive Substances: A Systematic Literature Review

Abstract

BackgroundAlcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals’ use is associated with a higher likelihood of developing several diseases and injuries and, as a consequence, considerable health-care expenditures. There is yet a lack of consistent methodologies to estimate the economic impact of addictive substances to society. The aim was to assess the methodological approaches applied in social cost studies estimating the economic impact of alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals.MethodsA systematic literature review through the electronic databases, Medline (PubMed) and Web of Science, was performed. Studies in English published from 1997 examining the social costs of the addictive substances alcohol, tobacco, illicit drugs, and psychoactive pharmaceuticals were eligible for inclusion.ResultsTwelve social cost studies met the inclusion criteria. In all studies, the direct and indirect costs were measured, but the intangible costs were seldom taken into account. A wide variety in cost items included across studies was observed. Sensitivity analyses to address the uncertainty around certain cost estimates were conducted in eight studies considered in the review.ConclusionDifferences in cost items included in cost-of-illness studies limit the comparison across studies. It is clear that it is difficult to deal with all consequences of substance use in cost-of-illness studies. Future social cost studies should be based on sound methodological principles in order to result in more reliable cost estimates of the economic burden of substance use.

Sympathy, Blame, and Just Allocation of Health Costs Entailed by Risky Conventional Lifestyles

“…It could also be that perceptions of the social and financial costs of care related to risky-lifestyle related disease vary greatly. Meta analyses show that even experts' estimates vary widely, depending on just what aspects they include (Verhaeghe et al, 2017).…”

Capturing the Invisible Wealth in Nonprofits to Overcome Myopic Perceptions

“…The previous literature considers the reduction in the quality of life for users as well as those closest to them, as a social cost that is both intangible [24,27,29] and invisible [23]. To measure the improvement in users' quality of life after treatment at the centre, the GENCAT Scale has been used, as it is the most appropriate instrument for assessing the individual quality of life of people with drug dependencies [35].…”

“…Consequently, users admitted to the programme for this reason, in line with the literature, represent a saving that is at least equivalent to the cost of a custodial sentence. Without accounting for the rest of the direct social costs established by the literature, such as police costs, judicial costs or property damage [23,27,29], the savings generated have been calculated on the basis of the average daily cost of a prison inmate [11,49].…”

“…As such, the study of the macroeconomic impact of addiction, primarily drug use, constitutes a well-established line of research, with numerous studies addressing the issue through the cost-of-illness (COI) methodology [23]. The fundamental goal of COI studies is to evaluate the economic burden that disease imposes on society as a whole [23,24,[26][27][28][29]. When carrying out COI studies, researchers need to recognize, identify, list, measure and value the costs that a particular disease can generate [30].…”

“…The indirect costs are those related to the loss of production or productive time associated with the presence of a disease. Last but not least, intangible costs refer to non-financial welfare losses such as reduced health-related quality of life due to physical or emotional suffering [24,27,29]. These costs are extremely complex to quantify because they rarely leave documentary evidence; they are "invisible" [11,31].…”