Basu Anirban, Paltiel A David, Pollack Harold A
Section of General Internal Medicine, Department of Medicine, Center for Health and the Social Sciences, University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA.
Health Econ. 2008 Aug;17(8):927-46. doi: 10.1002/hec.1305.
Reduced crime provides a key benefit associated with substance abuse treatment (SAT). Armed robbery is an especially costly and frequent crime committed by some drug-involved offenders. Many studies employ valuation methods that understate the true costs of robbery, and thus the true social benefits of SAT-related robbery reduction. At the same time, regression to the mean and self-report bias may lead pre-post comparisons to overstate crime reductions associated with SAT. Using 1992-1997 data from the National Treatment Improvement Evaluation Study (NTIES), we examined pre-post differences in self-reported robbery among clients in five residential and outpatient SAT modalities. Fixed-effect negative binomial regression was used to examine incidence rate reductions (IRR) in armed robbery. Published data on willingness to pay to avoid robbery were used to determine the social valuation of these effects. Differences in IRR across SAT modalities were explored to bound potential biases.All SAT modalities were associated with large and statistically significant reductions in robbery. The average number of self-reported robberies declined from 0.83/client/year pre-entry to 0.12/client/year following SAT (p<0.001). Under worst-case assumptions, monetized valuations of reductions in armed robbery associated with outpatient methadone and residential SAT exceeded economic costs of these interventions. Conventional wisdom posits the economic benefits of SAT. We find that SAT is even more beneficial than is commonly assumed.
减少犯罪是药物滥用治疗(SAT)带来的一项关键益处。武装抢劫是一些涉毒罪犯实施的一种特别代价高昂且频发的犯罪。许多研究采用的估值方法低估了抢劫的真实成本,从而也低估了与SAT相关的抢劫减少所带来的真正社会效益。与此同时,均值回归和自我报告偏差可能导致前后对比高估与SAT相关的犯罪减少情况。利用1992 - 1997年国家治疗改善评估研究(NTIES)的数据,我们研究了五种住院和门诊SAT模式下客户自我报告的抢劫行为的前后差异。使用固定效应负二项回归来检验武装抢劫的发病率降低情况(IRR)。利用已发表的关于为避免抢劫而愿意支付的费用的数据来确定这些影响的社会估值。探讨了不同SAT模式下IRR的差异以界定潜在偏差。所有SAT模式都与抢劫行为的大幅且具有统计学意义的减少相关。自我报告的抢劫平均次数从入院前的0.83次/客户/年降至接受SAT后的0.12次/客户/年(p<0.001)。在最坏情况下的假设下,与门诊美沙酮治疗和住院SAT相关的武装抢劫减少的货币化估值超过了这些干预措施的经济成本。传统观点认为SAT有经济效益。我们发现SAT比通常认为的更有益。