Economic evaluation techniques are designed to provide some clear guidance to decision makers on the choice, in value for money terms, between specific interventions. However, such evaluations require a range of assumptions to be taken and these choices may impact on the ranking of interventions. This article explores these issues that arise in providing such policy relevant estimates using data from a number of recently completed United Kingdom (UK) studies. The broad welfarist approach which considers all costs and consequences is contrasted to a decision-maker approach taking a more restrictive set of costs and outcomes.
The choice of perspective is shown to be an important issues affecting choices of different policies and interventions. Data from the UK studies also suggests there is currently insufficient evidence to support the general health outcome, Quality Adjust Life Years (QALYs) measure recommended by UK regulatory authorities to serve as a main individual drug user outcome. Crime and productivity costs have been a major part of many international evaluations but have mean measured and valued differently and different treatment across different studies can lead to different policy recommendations. The technicalities behind some economic studies should not obscure some of these important issues and the implications for intervention and policy choices.
Abou-SalehM.DavisP.RiceP.ChecinskiK.DrummondC.Maxwell (2007). The effectiveness and cost-effectiveness of enhanced counselling in the primary prevention Of Hepatitis C amongst injecting drug users: A randomised controlled trial.
2.
AdiY.Juarez-GarciaA.WangD.JowellS.FrewE.DayE.BaylissS. (2007). Oral naltrexone as a treatment for relapse prevention in formerly opioid dependent drug users: A systematic review and economic evaluation, Health Technology Assessment, 11(6).
3.
BelenkoS. (2005). Economic benefits of drug treatment: A critical review of the evidence for policy Mmakers. Treatment Research Institute at the University of Pennsylvania
4.
BrooksR. (1996). EuroQol: The current state of playHealth Policy, 37, 53–72.
5.
CaulkinsJ. (2005). Models pertaining to drug policy should vary over the course of a drug epidemic, In LingrenB. & GrossmanM. (eds.) Substance use: Individual behaviour, social interactions, markets and policies. Advances in Health Economics and Health Services Research, Volume 16. Amsterdam: Elsevier.
6.
DijkgraafM. G. W.van der ZandenB. P.de BorgieC. A. J. M.BlankenP.van ReeJ. M., & van den BrinkW. (2005). Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials, British Medical Journal, 330, 1297–1300.
7.
DrummondC.KouimtsidisC., & ReynoldsM. (2005). The effectiveness of cognitive behaviour therapy for opiate misusers in methadone maintenance treatment: A multicentre, randomised, controlled trial. UKCBTMM Study: United Kingdom Cognitive Behaviour Therapy Study in Methadone Maintenance Treatment. Drugs: Education, Prevention & Policy, 12(11), 69–76.
8.
GodfreyC.EatonG.McDougallC., & CulyerA. (2002). The economic and social costs of Class A drug use in England and Wales, 2000. Home Office Research Study 249, London: Home Office. Retrieved at: http://www.homeoffice.gov.uk/rds/pdfs2/hors249.pdf.
9.
GodfreyC.ParrottS.EatonG.CulyerC., & McDougall. (2005). Can we model the impact of increased treatment expenditure on the UK drug market? In LindgrenB. and GrossmanM. eds. Substance use: Individual behaviour, social interactions, markets and policies. Advances in Health Economics and Health Services Research, Volume 16, pp. 257–275, New York: Elsevier.
10.
GodfreyC.StewartD., & GossopM. (2004). Economic analysis of costs and consequences of the treatment of drug misuse: Two year outcome data from the National Treatment Outcome Research Study (NTORS), Addiction, 99(6), 697–707.
11.
GoldM. R.SiegelJ. E.RussellL. B., & WeinsteinM. C. (ed.) (1996) Cost-effectiveness in Health and Medicine, New York: Oxford University Press.
12.
GordonL.TinsleyL.GodfreyC., & ParrottS. (2006). The economic and social costs of Class A drug use in England and Wales, 2003/04. In SingletonN.MurrayR. and TinsleyL. (eds.) Measuring different aspects of problem drug use: methodological developments. Home Office Online Report 16/06. London: Home Office.
13.
GossopM.MarsdenJ.StewartD.LehmannP.EdwardsC.WilsonA., & SegarG. (1998). Substance use, health, and social problems of clients at 54 drug treatment agencies: Intake data from the National Treatment Outcome Research Study (NTORS), British Journal of Psychiatry, 173, 166–171.
14.
HealeyA.KnappM.AstinJ.GossopM.MarsdenJ.StewartD. (1998). Economic burden of drug dependency: Social costs incurred by drug users at intake to the National Treatment Outcome Research Study. British Journal of Psychiatry, 173, 160–165.
15.
KindP.HardmanG. & MacranS. (1999). UK population norms for EQ-5D. Discussion Paper 172. Centre for Health Economics, University of York.
16.
KoopmanschapM.RuttenF.van IneveldB., & RoijenL. (1995). The friction cost method for measuring indirect costs of disease, Journal of Health Economics, 15, 171–189.
17.
McCollisterK. E. & FrenchM. T. (2004). The relative contribution of outcome domains in the total economic benefit of addiction interventions: A review of first findings, Addiction, 98, 1647–1659.
18.
MacDonaldZ.TinsleyL.CollingwoodJ.JamiesonP., & PudneyS. (2005). Measuring the harm from illegal drugs using the Drug Harm Index, London: Home Office Online Report 24/05. Retrieved at: http://www.homeoffice.gov.k/rds/pdfs06/rdsolr0806.pdf.
19.
National Institute for Health and Clinical Excellence (NICE) (2004). Methods for technology appraisals, London: NICE.
20.
National Institute for Health and Clinical Excellence. (2006). Guidance for the evaluation of public health interventions. London: NICE.
21.
NealeJ.GodfreyC.ParrottS.TomkinsC., & SheardL. (2006). Barriers to the effective treatment of injecting drug users. Final report to the Department of Health. School of Health & Social Care, Oxford Brookes University: Oxford.
22.
SindelarJ. L.Jofre-BonetM.FrenchM.TTT., & McLellanA. T. (2004). Cost-effectiveness analysis of addiction treatment: Paradoxes of multiple outcomes, Drug and Alcohol Dependence, 73, 41–50.
23.
TangC. H.LuiJ. T.ChangC. W., & ChangW. Y. (2007). Willingness to pay for drug abuse treatment: Results from a contingent valuation study in Taiwan, Health Policy, 82, 251–262.
24.
UKATT Research Team. (2005). Cost-effectiveness of treatment for alcohol problems: Findings from the UK Alcohol Treatment Trial, British Medical Journal, 331(7516) 544–547.
25.
UKCBTMM Project Group. (2004). The effectiveness and cost effectiveness of cognitive behaviour therapy for opiate misusers in methadone maintenance treatment: A multicentre, randomised, controlled trial. Final report to the Department of Health. St George's Medical School: London.
26.
ZarkinG. A.CatesS. C., & BalaM. V. (2000). Estimating the willingness to pay for drug abuse treatments: A pilot study, Journal of Substance Abuse Treatment, 18, 409–418.
