P A P A N A S T A S A T O S Economic Evaluation

Economic Evaluation of Substance Abuse Treatments: Aspects, Implications, Challenges Gerasimos Papanastasatos , PhD and Petros Triantos MSc KETHEA Research D epartment Therapy Center For Dependent Individuals (KETHEA) Athens, GREECE

Evaluation: a meaning to define ,[object Object],[object Object],[object Object],[object Object],( Patton, 1997; WHO, 2000;DHHS, 2005)

Systematic evaluation of substance abuse program includes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Basic assumptions ,[object Object],[object Object],[object Object],[object Object],(Aneurin Bevin, 1948)

Evaluation: Common views ,[object Object],[object Object],[object Object],[object Object],“ Flossing Your teeth” (You hate to do it but you know it should be done) “ Doing your taxes when you know you won’t get a refund” (Something to post off until the last possible moment) “ Doing a stage performance and having your clothes fall off” (Submitting to the risk of public exposure)

The skepticism even with good intentions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Pragmatist –and maybe distressing – answers ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The necessity for economic evaluation institutional context

[object Object],[object Object],[object Object],[object Object],The necessity for economic evaluation fuctional persuasiveness

Defining economic evaluation ,[object Object],Drummond et. al, 1987

Two big questions remain open ,[object Object],[object Object]

Drug Abuse Treatment Core Components and Comprehensive Services Medical Mental Health Vocational Educational Legal AIDS / HIV Risks Financial Housing & Transportation Child Care Family Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 ( PAB ) core treatment Continuing Care Case Management Urine Monitoring Self-Help (AA/NA) Pharmaco-therapy Group/Individual Counseling Abstinence Based Intake Assessment Treatment Plans

What does Economic Evaluation Involve? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Measuring Costs ,[object Object],[object Object],[object Object]

Measuring Costs: defining opportunity cost ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Types of economic evaluation Cost-Effectiveness Mostly used until 1980 in medicine. It is based in the comparison between cost and ONE effectiveness index ( i.e. life years gained as a result of a treatment ) Cost-Utility Similar to Cost-effectiveness focus is on only one effectiveness index. Introducing the quality factor ( i.e. quality life years gained /QALY as a result of a treatment) Cost- Benefit Conversion of selected effectiveness indexes into monetary units and comparison to opportunity cost for the operation of a treatment setting.

[object Object],[object Object],[object Object],Research Experience (restrains)

[object Object],[object Object],[object Object],[object Object],[object Object],Research Experience (steps done)

Economic Evaluation: literature Review in US therapeutic programs ,[object Object],[object Object],[object Object],(Mc Allister &French, 2002)

[object Object],[object Object],[object Object],[object Object],[object Object],Methodology (cost monitoring – logistic phase)

Methodology (effectiveness measurement) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methodology (economization)

Methodology (analogistic phase) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Procedures’ stages summary logistic outcome economization analogistic DATCAP ASI / EuropASI Translation in monetary units Conclusions

Cost Analysis Tool: DATCAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(French 2001a, 2001b, www.DATCAP.com)

Effectiveness Analysis Tool: ASI and EuropASI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(McLellan, Kushner, Metzger, et al.1992; McLellan et al.1980)

[object Object],[object Object],[object Object],The skepticism continues Critics on Economic Evaluation Methodology (Mc Allister &French, 2002)

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Subjects for further examination ( Reuter 1999, French, Salome et al. 2000 )

P A P A N A S T A S A T O S Economic Evaluation

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P A P A N A S T A S A T O S Economic Evaluation