Healey Andrew, Knapp Martin, Marsden John, Gossop Michael, Stewart Duncan
LSE Health and Social Care and PSSRU, London School of Economics and Political Science, London, UK.
J Health Serv Res Policy. 2003 Jul;8(3):134-41. doi: 10.1258/135581903322029476.
To assess the incremental cost-effectiveness of drug addiction treatment programmes provided in the UK by the National Health Service and not-for-profit agencies in terms of crime-related outcomes. All costs and crime-related outcomes were implicitly evaluated relative to a 'no treatment' alternative.
Longitudinal observational data on a national sample of heroin addicts referred to addiction treatment services throughout England were re-analysed. Predictions from a Poisson random-effects model were used to estimate the incremental effectiveness and cost-effectiveness of treatment programmes. Interaction variables were used to assess whether the injecting of heroin on entry to treatment had an impact on cost-effectiveness.
The findings rejected the null hypothesis that increasing time in treatment (and therefore treatment cost) has no mean crime prevention effect on clients referred for community-based methadone treatment, treatment delivered within specialist drug dependency units and residential rehabilitation programmes (P < 0.05). However, the size of the cost per unit of effect based on model predictions was sensitive to the exclusion of a small group of outlying observations. The interaction between client injecting status and time in treatment was found to be statistically significant (P < 0.05), with an estimated reduction in treatment cost-effectiveness across all treatment programmes for clients who reported injecting drugs at treatment intake.
Whilst the analyses did not include an evaluation of the effect of treatment programmes on client health and quality of life and stopped short of providing a social weighting for the predicted reduction in crimes, they do offer a useful starting point for establishing the cost-effectiveness of treating heroin addiction. The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services.
从与犯罪相关的结果方面评估英国国家医疗服务体系和非营利机构提供的药物成瘾治疗项目的增量成本效益。所有成本和与犯罪相关的结果均相对于“不治疗”的替代方案进行了隐含评估。
对英格兰各地转介至成瘾治疗服务机构的全国海洛因成瘾者样本的纵向观察数据进行了重新分析。使用泊松随机效应模型的预测来估计治疗项目的增量效果和成本效益。使用交互变量来评估治疗开始时注射海洛因是否对成本效益有影响。
研究结果拒绝了原假设，即增加治疗时间（进而增加治疗成本）对转介接受社区美沙酮治疗、在专业药物依赖单位进行的治疗以及住院康复项目的患者没有平均预防犯罪效果（P < 0.05）。然而，基于模型预测的单位效果成本大小对排除一小部分离群观测值很敏感。发现患者注射状态与治疗时间之间的交互作用具有统计学意义（P < 0.05），对于报告在治疗开始时注射毒品的患者，所有治疗项目的治疗成本效益估计均有所降低。
虽然分析未包括对治疗项目对患者健康和生活质量影响的评估，也未对预测的犯罪减少进行社会加权，但它们确实为确定治疗海洛因成瘾的成本效益提供了一个有用的起点。公共决策者有责任决定预测的犯罪减少是否值得在大幅扩大治疗服务方面投入额外资源的机会成本。
