TY - JOUR
T1 - Service use and cost by mentally ill chemical abusers
T2 - Differences by retention in a therapeutic community
AU - McGeary, Kerry Anne
AU - French, Michael T.
AU - Sacks, Stanley
AU - McKendrick, Karen
AU - De Leon, George
N1 - Funding Information:
The authors acknowledge funding for this research from several grants awarded by the National Institute on Drug Abuse (NIDA) (RO1 DA09776, R01 DA11506, and P50 DA07705). The research benefited from the invaluable assistance of Wagih Awad, Kathryn McCollister, Graham Staines, and JoAnne Sacks. In addition, we thank Carmen Martinez, Jo Scraba, Ron Newman, Silvana Zavala, and Chris Roebuck for their expert support in the preparation of this manuscript.
PY - 2000
Y1 - 2000
N2 - Purpose: Earlier research estimated the incremental costs and outcomes of a modified therapeutic community (modified TC) for mentally ill chemical abusers (MICAs) relative to a treatment-as-usual (TAU) control group. The present study extended the cost analysis by disaggregating the modified TC group into clients who completed the program (completers) and clients who dropped out (separaters). Methods: Bivariate and multivariate analyses were conducted to estimate differences in treatment and other service costs among completers, separaters, and TAU. Subjects were sequentially assigned to the modified TC (n = 171) or TAU (n = 47), and the analysis period covered 12 months post-baseline. Using a standardized instrument to collect resource use and cost data, the estimated weekly cost per client in the modified TC was $554, with completers showing a larger average cost of treatment ($27,595) than separaters ($9,986). Results: The average TAU subject had a much higher cost for other (non-modified TC) services ($29,795) relative to separaters ($22,048) or completers ($1,986). These findings suggest that, from baseline to the 12-month follow-up, the total cost of modified TC treatment and other services for completers may be slightly lower than the total cost for separaters or TAU subjects. Since the modified TC group had better outcomes than the TAU group, and the completers had better outcomes than the separaters, the modified TC program could be an effective mechanism to reduce the costs of service utilization as well as improve clinical outcomes. Implications: This detailed investigation into service utilization and cost provides policy-makers and program directors with valuable information regarding potentially cost-effective interventions and further underscores the importance of retention in treatment for this vulnerable population.
AB - Purpose: Earlier research estimated the incremental costs and outcomes of a modified therapeutic community (modified TC) for mentally ill chemical abusers (MICAs) relative to a treatment-as-usual (TAU) control group. The present study extended the cost analysis by disaggregating the modified TC group into clients who completed the program (completers) and clients who dropped out (separaters). Methods: Bivariate and multivariate analyses were conducted to estimate differences in treatment and other service costs among completers, separaters, and TAU. Subjects were sequentially assigned to the modified TC (n = 171) or TAU (n = 47), and the analysis period covered 12 months post-baseline. Using a standardized instrument to collect resource use and cost data, the estimated weekly cost per client in the modified TC was $554, with completers showing a larger average cost of treatment ($27,595) than separaters ($9,986). Results: The average TAU subject had a much higher cost for other (non-modified TC) services ($29,795) relative to separaters ($22,048) or completers ($1,986). These findings suggest that, from baseline to the 12-month follow-up, the total cost of modified TC treatment and other services for completers may be slightly lower than the total cost for separaters or TAU subjects. Since the modified TC group had better outcomes than the TAU group, and the completers had better outcomes than the separaters, the modified TC program could be an effective mechanism to reduce the costs of service utilization as well as improve clinical outcomes. Implications: This detailed investigation into service utilization and cost provides policy-makers and program directors with valuable information regarding potentially cost-effective interventions and further underscores the importance of retention in treatment for this vulnerable population.
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U2 - 10.1016/S0899-3289(00)00026-2
DO - 10.1016/S0899-3289(00)00026-2
M3 - Article
C2 - 11026125
AN - SCOPUS:0033760003
VL - 11
SP - 265
EP - 279
JO - Journal of Substance Abuse
JF - Journal of Substance Abuse
SN - 0899-3289
IS - 3
ER -