Alemi Farrokh, Taxman Faye, Baghi Heibatollah, Vang Jee, Thanner Meridith, Doyon Victoria
George Mason University, Department of Health Administration and Policy, College of Health and Human Services, 4400 University Drive, Fairfax, Virginia 22030, USA.
J Ment Health Policy Econ. 2006 Jun;9(2):57-70.
We compared seamless combination of probation and treatment (where the probation officer is co-located with treatment provider or is actively engaged in treatment) to traditional probation where treatment is left to the client's choice.
Clients were randomly assigned to either seamless or traditional probation. We used a decision analytic approach which had two advantages: First it separated estimation of probability of adverse events (e.g. hospitalization) from the daily cost of the adverse event, thereby allowing use of estimates of daily costs available within the literature. Second, the reliance on daily probability of various adverse events also had the benefit of reflecting both length of the event and its intermittent re-occurrence. Subjects were 272 clients on probation in Northern Virginia and Maryland in the United States. Clients were randomly assigned to seamless and traditional probation and were followed for an average of 2.75 years (arrest information was only available for 1 year); 77% of clients participated in the follow-up interviews. At baseline, there was no statistically significant difference among the clients.
During the follow-up period, clients in the seamless probation had less recidivism but the cost savings from this component (dollar 2.31 per client per follow-up day) was not sufficient to overcome increased costs due to mental hospitalization of seamless clients (dollar 13.50 per client per follow-up day), cost of delivery of seamless probation (dollar 2.58 per client per follow-up day), more frequent use of jail/prison for clients in the seamless group (dollar 2.08 per client per follow-up day) and additional treatment costs (dollar 1.24 per client per follow-up day). The expected cost of seamless probation and its consequences was dollar 38.84 per follow-up day. The expected cost of traditional probation and its consequences was dollar 21.60 per follow-up day. Seamless probation was dollar 6,293 more expensive than traditional probation per client per year.
Sensitivity analysis suggested that the analysis was not sensitive to small change in any single cost or probability estimate. Sensitivity analysis suggested that increased supervision intensity and use of sanctions had contributed to lower cost-effectiveness.
One possible way of improving seamless probation is to improve the intensity of the substance abuse treatment while reducing the intensity of supervision to its traditional levels. This analysis was limited to 2.75 years follow-up period and does not address cost savings that might occur after this period.
我们将缓刑与治疗的无缝结合（缓刑监督官与治疗提供者同处一处或积极参与治疗）与传统缓刑（治疗由客户自行选择）进行了比较。
客户被随机分配到无缝缓刑组或传统缓刑组。我们采用了一种决策分析方法，该方法有两个优点：第一，它将不良事件（如住院）的概率估计与不良事件的每日成本分开，从而能够使用文献中可用的每日成本估计值。第二，依赖各种不良事件的每日概率还有利于反映事件的持续时间及其间歇性复发。研究对象是美国弗吉尼亚州北部和马里兰州的272名缓刑客户。客户被随机分配到无缝缓刑组和传统缓刑组，并平均随访2.75年（逮捕信息仅可获取1年）；77%的客户参与了随访访谈。在基线时，客户之间没有统计学上的显著差异。
在随访期间，无缝缓刑组的客户再犯率较低，但该部分节省的成本（每位客户每天随访2.31美元）不足以抵消无缝缓刑组客户因精神住院增加的成本（每位客户每天随访13.50美元）、无缝缓刑的实施成本（每位客户每天随访2.58美元）、无缝缓刑组客户更频繁使用监狱的成本（每位客户每天随访2.08美元）以及额外的治疗成本（每位客户每天随访1.24美元）。无缝缓刑及其后果的预期成本为每天随访38.84美元。传统缓刑及其后果的预期成本为每天随访21.60美元。无缝缓刑比传统缓刑每位客户每年贵6293美元。
敏感性分析表明，该分析对任何单个成本或概率估计的微小变化不敏感。敏感性分析表明，增加监督强度和使用制裁措施导致成本效益降低。
改善无缝缓刑的一种可能方法是提高药物滥用治疗的强度，同时将监督强度降低到传统水平。该分析仅限于2.75年的随访期，未涉及该时间段之后可能节省的成本。
