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Table 3 Studies that reported substance use disorders

From: The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review

Studies considering costs and effects of substance abuse

Dennis (2004) [29]

 

Costs intervention and comparators (per episode of care per patient) (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)

 In trial 1 MET/CBT 5,MET/CBT 12 and FSN were compared. In trial 2 MET/CBT 5, ACRA and MDFT were compared. Costs were collected with a program (DATCAP) which yields estimates such as the total annual opportunity cost of treatment and the labor cost per client.

Difference cost

 The difference in costs were not showed in this study. However, it was showed that the differences were significant.

 MET/CBT 5 (trial 1):

 € 1,226

 MET/CBT 12 (trial 1):

 € 1,305

 FSN (trial 1):

 € 3,576

MET/CBT 5 (trial 2):

€1,716

ACRA (trial 2):

€ 1,551

MDFT (trial 2):

€ 2,205

 

Effects intervention and comparators (per patient) (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)

Difference effects

 

 Met CBT 5 (trial 1)

 Days of abstinence: 269

 Recovery*: 28 %

 Met CBT 12 (trial 1)

 Days of abstinence: 256

 Recovery: 17 %

 MET FSN (trial 1)

 Days of abstinence: 260

 Recovery: 22 %

 *Recovery is defined as having no use or abuse dependence problems and living in the community

Met CBT 5 (trial 2)

Days of abstinence: 251

Recovery: 23 %

ACRA (trial 2)

Days of abstinence: 265

Recovery: 34 %

MDFT (trial 2)

Days of abstinence: 257

Recovery: 19 %

 The difference in effects were not showed in this study However it was showed that the difference was not significant.

Results

Cost per day of abstinence:

 Met CBT5 (trial 1): € 541

 Met CBT 12: € 677

 Met FSN: € 1,667

Costs per person in recovery

 Met CBT5 (trial 1): € 4,360

 Met CBT 12: € 41,172

 Met FSN: € 16,651

Cost per days of abstinence:

 MET/CBT5 (trial 2): € 991

 ACRA: € 729

 MDFT: € 1,143

Costs per person in recovery

 MET/CBT5 (trial 2): € 7,337

 ACRA: € 4,913

 MDFT: € 12,970

French (2008) [25]

 

Costs intervention per patient (FFT, Joint and CBT)

 FFT:

 Treatment costs: € 1,817

 Joint:

 treatment costs: € 2,847

 CBT:

 Treatment costs: € 1.439

Costs comparator per patient (Group)

 Group:

 Treatment costs: € 990

Difference costs

 The difference in costs were not showed in this study

Effects intervention per patient (FFT, Joint and CBT)

 FFT:  % days marijuana use 4 months: 25.3

 %of days marijuana use 7 months:39.8

 YSR delinquency score 4 months: 8.2

 YSR delinquency score 7 months:9.2

 Joint

 % of days of marijuana use 4 months: 38.1

 marijuana use 7 months:35.4

 YSR delinquency score 4 months: 9.1

 YSR delinquency score 7 months:8.5

 CBT % of days marijuana use 4 months: 50.6

 % of days marijuana use 7 months:51.8 YSR delinquency score 4 months: 10.2

 YSR delinquency score 7 months:10.4

Effects comparator per patient (Group)

 Group

 % of days of marijuana use 4 months: 54.8

 marijuana use 7 months: 40.7

 YSR delinquency score 4 months: 9.5

 lYSR delinuency score 7 months: 9.4

Difference effects with regression model:

 FFT versus group:

 % days marijuana use after 4 months: −20.11*

 % days marijuana use after 7 months: 4.87

 YSR delinquency score 4 months: −0.60

 YSR delinquency score 7 months: 0.15

 CBT versus group

 % days marijuana use after 4 months: 4.76

 % days marijuana use after 7 months: 18.27

 YSR delinquency score 4 months: 0.38

 YSR delinquency score 7 months: 0.42

 Joint versus group

 % days marijuana use after 4 months: −14.86

 % days marijuana use after 7 months “-2.00

 YSR delinquency score 4 months: −0.50

 YSR delinquency score 7 months: −1.50

Joint versus group

Delinquency score after 4 months: −0.50

Delinquency score after 7 months: −1.50

Results

Group therapy was most cost-effective, none of the other therapies were significantly different in effect compared to group therapy. So the intervention with the lowest costs was considered to be most cost-effective.

Sheidow (2012) [27]

 

Costs Intervention (DC, DC + MST, DC + MST + CM)

 Treatment costs DC: € 9,083

 Treatment costs DC + MST: € 12,369

 Treatment costs DC + MST + CM: € 12,859

Costs comparator (FC)

 Treatment costs FC:

 € 3,679

Difference costs:

 The difference in costs were not shown in this study

Effects intervention (DC, DC + MST, DC + MST + CM)

 DC

 Marijuana use (days): −16.65

 Polydrug use (days): 1.41

 Alcohol use (days): 0.49

 Heavy alcohol use (days): 0.86

 SRD status offenses (incidents): −7.24

 SRD Theft (incidents): −3.28

 SRD crimes against persons (incidents): −2.69

 DC ± MST

 Marijuana use (days): −30,17

 Polydrug use (days): :-1.11

 Alcohol use (days): 0.27

 Heavy alcohol use (days): −0.45

 SRD status offenses (incidents): −11.11

 SRD Theft (incidents): −2.79

 SRD crimes against persons (incidents): −3.90

 DC ± MST ± CM

 Marijuana use (days): −27.86

 Polydrug use (days): −6.76

 Alcohol use (days): −7.56

 Heavy alcohol use (days): −4.13

 SRD status offenses (incidents): −10.38

 SRD Theft (incidents): −3.19

 SRD crimes against persons (incidents): −2.4

Effects comparator (FC)

 Marijuana use (days): −15,43

 Polydrug use (days): 2.27

 Alcohol use (days): 2.97

 Heavy alcohol use (days): 0.76

 SRD status offenses (incidents): 9.22

 SRD Theft (incidents): −5.54

 SRD crimes against persons (incidents): 0.49

Difference effects:

 The difference in effects were not showed in this study

Results

ACERS were calculated; average costs/ difference between mean incidents before and after treatment (negative means inefficient)

 

FC

DC

DC + MST

DC + MST + CM

Marijuana use:

Polydrug use:

Alcohol use:

Heavy alcohol use:

SRD status offenses:

SRD theft:

SRD crimes against persons:

€ 238 (215–262)

€ −1,619 (−8,8839–5,601)

€ −,1,239 (−6,546–5,601)

€ −4,857 (−10,632–918)

€ −400 (−1,206–398)

€ 663 (428–899)

€ −7,588 (−10,667–4,510)

€ 545 (474–617)

€ −6,425 (−27,541–14,692)

€ −18,814 (−42,034–4,405)

€ −10,535 (−28,804–7,733)

€ 1,254 (1,132–1,376)

€ 2,773 (−2.441–7,987)

€ 3,377 (2,976–3,777)

€ 410 (377–442)

€ 11,209 (−3,757–26,175)

€ −44,838 (−61,014–28,662)

€ 27,592 (−14,636–69,821)

€ 1,114 (907–1,321)

€ 4,428 (−1,224–10,081)

€ 3,175 (236–6,123)

€ 461 (434–488)

€ 1,912 (1,624–2,182)

€ 1,699 (1,486–1,912)

€ 3,109 (1,708–4,511)

€ 1,239 (1,009–1,496)

€ 4,032 (1,204–6,859)

€ 5,346 (4,723–5,968)

Studies considering costs and benefits of substance abuse

Schoenwald (1996) [32]

Costs interventions (MST)

 Mental health outpatient (total): €4,242

 Mental health day treatment (total): € 5,423

 Mental health residential treatment (total): €6,899

 Psychiatric inpatient (total): €15,752

 Psychiatric emergency room (total): €1,150

 Substance abuse outpatient (total): € 2,001

 Substance abuse residential treatment (total): €3,450

 Substance abuse inpatient (total): € 16,098

 Marine Institute day treatment (total): € 18,926

 Marine Institute residential treatment (total): € 3,036

 Treatment costs: € 266,516

Costs comparator (CAU)

 Mental health outpatient (total): € 19,075

 Mental health day treatment (total): € 1,118

 Mental health residential treatment (total): €0

 Psychiatric inpatient (total): €18,513

 Psychiatric emergency room (total): €3,450

 Substance abuse outpatient (total): € 20,272

 Substance abuse residential treatment (total): €43,695

 Substance abuse inpatient (total): €93,771

 Marine Institute day treatment (total): €28,618

 Marine Institute residential treatment (total): €0

Benefits interventions

Incarceration days: €65,427

Benefits CAU

Incarceration days: €120,851

 

Results

MST: Total costs (costs + benefit) with incarceration = €408,919 and the total costs (costs + benefit) with incarceration per youth = €6,930

CAU: Total costs (costs + benefit) with incarceration = € 335,845 and the costs (costs + benefit) per youth = €5,693.

Difference in total between groups = €1,019

French (2003) [22]

Costs interventions (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)

Benefits interventions (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)

 Treatment costs were measured

 Health service utilization; Outpatient clinic/doctor’s office visit

 Days bothered by health/medical problem

 Substance-absue treatment utilization; Days in detoxification program; Day in inpatient treatment program; Day in long-term residential program; Intensive outpatient program visits; Regular outpatient program visits

 Education and employment; Days missed at school or training; Personal income; Days stressful for parents

 Day missed of work or school by parent

 Criminal activity; Arrests; Day on probation; Days on parole; Days in prison/jail; Days in juvenile detention

 Incremental arm:

 MET/CBT5:€ 1,226

 MET/CBT12: € 1,305

 FSN: € 3,576

 Alternative arm:

 MET/CBT5: € 1,716

 ACRA: € 1,551

 MDFT: € 2,216

 Incremental arm:

 MET/CBT5

 Baseline € 2,553

 3 months: € 2,133

 6 months: € 1,671

 9 months: € 945

 12 months: € 1,217

 MET/CBT12

 Baseline: € 2,179

 3 months: € 2,433

 6 months: € 828

 9 months: € 1,431

 12 months: € 687

 FSN:

 Baseline: € 2,552

 3 months: € 4,525

 6 months: € 1,783

 9 months: € 1,205

 12 months: € 1,726

Alternative arm:

MET/CBT5

Baseline € 2,694

3 months: € 3,587

6 months: € 2,213

9 months: € 2,275

12 months: € 1,907

ACRA

Baseline: € 2,506

3 months: € 3,691

6 months: € 1,748

9 months: € 3,113

12 months: € 3,237

MDFT:

Baseline: € 2,019

3 months: € 3,938

6 months: € 1,467

9 months: € 2,573

12 months: € 2,098

 

Results

Net economic benefits (benefits + costs) relative to baseline:

3 different models were administred; Model 1: only time dummies for each of the follow-up periods (as treatment conditions were not included, we did not show the results.

Model 2: time dummies and indicator variables for treatment condition.

Model 3: time and treatment variables withan indicator variable for site. The last specification added numerous demographic and environmental controls.

MET/CBT12:

Model 2: € −198 (349)

Model 3: € −171 (346)

Model 4: € −340 (334)

FSN:

Model 2: € 607* (343)

Model 3: € 653 (340)

Model 4: € 250 (333)

*p < 0.1

Acra:

Model 2: € 369 (436)

Model 3: € 530 (430)

Model 4: € 554 (405)

MDFT

Model 2: −€ 61 (441)

Model 3: € 128 (436)

Model 4: € 100 (530)

McCollister (2009) [24]

 

Costs interventions (DC, DC/MST, DC)

Costs comparators (FC)

Benefits interventions (DC, DC/MST, DC)

Benefits comparators (FC)

Treatment costs

Treatment costs

 Criminal activity costs according to Self-reported criminal activity (SRD):

 DC:

 € 28.601 (94.314)

 DC/MST:

 €65.640 (240.559)

 DC/MST/CM:

 €80.222 (336.461)

 Self-reported criminal activity (SRD):

 FC: € 206.045 (545.581)

 DC:

 €8,156

 DC/MST:

 €11,547

 DC/MST/CM:

 € 11,547

 FC:

 €3,304

Results

After 12 months, total costs relative to FC with multivariate model (intervention costs not incorporated):

DC: € -124,877 (−84,107)

DC/MST: €-117,918 (−82,570)

DC/MST/CM: €140,274 (/79.066)*

All DC conditions generated reduction in crime costs, greater than average costs of treatment.

  1. Currency and price year: Sheidow (2004).USD, 1997; Dennis (2004).USD, 1999; French 2008.USD, 1998; Sheidow (2012).USD 2004. When a price year was not stated it was estimated by taking the mean year of the study duration or when not available subtracting 1 from the year of publication of the study
  2. MST multisystemic therapy, Joint combination of individual and family therapy, group skill-focused psycho-education group intervention, CAU care as usual, FSN family support network, MDFT multidimensional family treatment, MET/CBT12 motivational enhancement treatment/cognitive behavior therapy, 12 sessions, MET/CBT5 motivational enhancement treatment/cognitive behavior therapy, 5 sessions, Acra adolescent community reinforcement approach, DC drug court with community services, DC + MST drug court with multisystemic therapy; DC + MST + CM drug court with MST and enhanced with a contingency management programs, FFT functional family therapy, FC family court with community services, ACERS average cost-effectiveness ratios