Horn Brady P, Li Xiaoxue, McCrady Barbara, Guerin Paul, French Michael T
Department of Economics, University of New Mexico, MSC 05 3060, 1 University of New Mexico, Albuquerque, NM 87131, USA; Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, 2650 Yale SE MSC11-6280, Albuquerque, NM 87106, USA.
Department of Economics, University of New Mexico, MSC 05 3060, 1 University of New Mexico, Albuquerque, NM 87131, USA.
J Subst Abuse Treat. 2020 Aug;115:108042. doi: 10.1016/j.jsat.2020.108042. Epub 2020 May 28.
The U.S. has the second-highest incarceration rate in the world and spends more than $80 billion annually to house inmates. The clinical research literature suggests that methadone maintenance treatment (MMT) is an effective method to treat opioid use disorders (OUD) and that jails are a potentially valuable environment to implement MMT. Currently, jail-based MMT is rarely implemented in practice, due in part to resource limitations and other economic considerations. The primary goal of this study was to perform a cost-effectiveness analysis (CEA) of jail-based MMT using data from a unique MMT continuation program located in a large urban jail in New Mexico. Recidivism data were collected for a three-year period both before and after incarceration, and quasi-control groups were constructed from both substance-using and general populations within the jail. Base models show that inmates enrolled in jail-based MMT exhibited significantly fewer days of incarceration due to recidivism (29.33) than a group of inmates with OUDs who did not receive MMT. Economic estimates indicate that it cost significantly less ($23.49) to reduce an incarcerated day using jail-based MMT than incarceration per se ($116.49). To mitigate potential sample selection bias, we used both propensity-score-matching and difference-in-differences estimators, which provided comparable estimates when using the OUD non-MMT comparison group. Difference-in-differences models find that, on average, MMT reduced recidivism by 24.80 days and it cost $27.78 to reduce an incarcerated day using jail-based MMT. Assuming a willingness to pay threshold of the break-even cost of reducing one incarcerated day, we estimate a 93.3% probability that this MMT program is cost-effective. Results were not as strong or consistent when using other comparison groups (e.g., alcohol-detoxified and general-population inmates). Overall, results suggest that it costs substantially less to provide jail-based MMT than incarceration alone. Jail administrators and policymakers should consider incorporating MMT in other jail systems and settings.
美国的监禁率在世界上排名第二，每年花费超过800亿美元用于关押囚犯。临床研究文献表明，美沙酮维持治疗（MMT）是治疗阿片类药物使用障碍（OUD）的有效方法，而监狱是实施MMT的一个潜在的有价值的环境。目前，基于监狱的MMT在实践中很少实施，部分原因是资源限制和其他经济因素。本研究的主要目标是利用来自新墨西哥州一个大型城市监狱的独特MMT延续项目的数据，对基于监狱的MMT进行成本效益分析（CEA）。在监禁前后的三年时间里收集了累犯数据，并从监狱内的吸毒人群和普通人群中构建了准对照组。基础模型显示，参加基于监狱的MMT的囚犯因累犯而被监禁的天数（29.33天）明显少于一组未接受MMT的患有OUD的囚犯。经济估计表明，使用基于监狱的MMT减少一天监禁的成本（23.49美元）明显低于监禁本身的成本（116.49美元）。为了减轻潜在的样本选择偏差，我们使用了倾向得分匹配和差异估计器，在使用OUD非MMT比较组时，它们提供了可比的估计。差异估计模型发现，平均而言，MMT将累犯率降低了24.80天，使用基于监狱的MMT减少一天监禁的成本为27.78美元。假设支付意愿阈值为减少一天监禁的收支平衡成本，我们估计这个MMT项目具有成本效益的概率为93.3%。当使用其他比较组（如戒酒和普通囚犯）时，结果没有那么有力和一致。总体而言，结果表明，提供基于监狱的MMT的成本比单独监禁要低得多。监狱管理人员和政策制定者应考虑在其他监狱系统和环境中纳入MMT。
