The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement

French, Michael T.; Popovici, Ioana; Tapsell, Lauren M.

doi:10.1016/j.jsat.2007.12.008

Cited by 72 publications

(72 citation statements)

References 29 publications

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“…Health economists estimate that the resource cost of providing an episode of methadone maintenance can range from $1500 to $8000, depending on the length of the episode, while the cost of providing an episode of non-methadone substance use disorder treatment can range from $1000–$5000 (French, Popovici, & Tapsell, 2008). The out-of-pocket cost to patients depends largely on insurance coverage.…”

mentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Friedman

Harwood

et al. 2017

Journal of Substance Abuse Treatment

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Background: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Methods: Claims and eligibility data from 5,987,776 enrollees, 2008–2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008–2009), during (2010), and after (2011 — 2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N = 2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Results: Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p = 0.01]; $28.33 [p = 0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p = 0.01]; 0.02 visits [p = 0.01]; 0.01 visits [p = 0.03]; 0.01 days [p = 0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p = 0.00]; $2.25/month [p = 0.00]; $0.27 [p = 0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p = 0.01]; 0.0012 days/month [p = 0.00]). Conclusion: MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization. These increases, while modest in magnitude, are larger in magnitude than increases detected among a sample of all enrollees (i.e. not only those with SUD diagnoses).

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confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Friedman

Harwood

et al. 2017

Journal of Substance Abuse Treatment

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“…French et al, (2008) reported the average cost per episode for different SUD treatment modalities as well as cost bands for each estimate (French, Popovici, & Tapsell, 2008). These estimates are based on more than 100 studies that collected primary data on treatment program resources used and associated costs using the Drug Abuse Treatment Cost Analysis Program (DATCAP) (French, 2003).…”

Section: Resultsmentioning

confidence: 99%

Monetary conversion factors for economic evaluations of substance use disorders

McCollister

Yang

Sayed

et al. 2017

Journal of Substance Abuse Treatment

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Aims Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. Methods Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. Results Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. Conclusions Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates.

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“…This can be costly for patients over time (French, Popovici, and Tapsell, 2008). Prior work documents that expenditures are substantially higher among privately-insured, non-elderly adults with SUD diagnoses compared to the same population as a whole (Harwood et al 2017; Friedman et al 2017).…”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

Friedman

Azocar

et al. 2018

Drug and Alcohol Dependence

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Background: To assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e. copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services. Methods: MH and SUD copayments and coinsurance, 2008–2013, were obtained from benefits databases for “carve-in” and “carve-out” plans from Optum®. Linear regression was used to estimate the association of MHPAEA with differences between specialty MH and SUD care financial requirements among “carve-in” and “carve-out” plans. A two-part regression model investigated whether MHPAEA was associated with changes in the use or level of financial requirements for SUD-specific services among “carve-out” plans. Results: MHPAEA was not associated with significant changes in the difference between SUD and MH copayments or coinsurance levels among either “carve-in” or “carve-out” plans. MHPAEA was associated with decreases in the levels of inpatient (in-network: −$51.17; out-of-network: −$34.39) and outpatient (in-network: −$10.26) detox copayments, but increases in the levels of in-network outpatient detox coinsurance (6 percentage points) among all “carve-out” plans. Conclusion: Even if SUD benefits had been historically less generous than MH benefits, SUD financial requirements were already at parity with MH financial requirements by the time MHPAEA was passed, among Optum® plans. MHPAEA’s SUD parity mandate reduced cost-sharing for detox services via copayments, but, for outpatient detox, the law simultaneously increased cost-sharing via coinsurance.

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The economic costs of substance abuse treatment: Updated estimates and cost bands for program assessment and reimbursement

Cited by 72 publications

References 29 publications

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Monetary conversion factors for economic evaluations of substance use disorders

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

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