1009 — The Cost of Substance Use Rehabilitation across the Continuum of Settings
Barnett PG (Health Economics Resource Center) , Gage M
(Health Economics Resource Center), Tiet QQ
(Center for Health Care Evaluation), Finney JW
(Center for Health Care Evaluation)
VA and private insurance plans have reduced the cost of substance use treatment by shifting to less restrictive settings. We examined the factors that govern the relationship between treatment setting and cost.
We randomly selected 50 VA substance treatment programs from groups defined by treatment setting. Program managers answered surveys about staffing and workload. There were 1,959 patients assessed at baseline and followed in VA databases; 1,293 were resurveyed an average of 7 months later.
Inpatient treatment was more expensive than residential treatment ($13,906 vs $10,143 per stay), but inpatient stays were shorter (30.9 vs. 52.9 days). Inpatient programs were smaller and staffed more intensively. They served significantly more patients with schizophrenia (25% vs. 5%), bipolar disorder (22% vs. 10%), and PTSD (25% vs. 17%). Domiciliary programs had longer stays (82.6 days), higher costs ($16,693), and a case-mix similar to that of residential programs. Intensive outpatient programs served significantly more patients with cocaine and opioid diagnoses than regular outpatient programs, and were most costly ($3,988 compared to $2,060 per episode). Intensive outpatient programs were visited more frequently over a longer episode (78 vs. 58 days). They did not differ in daily cost or intensity of services, staffing levels, or staff training. At follow-up, there was a significant improvement in mean alcohol and drug problem scores for patients in all settings. Improvement was significantly greater among inpatients than among patients in either type of outpatient program, and was greater for patients in intensive outpatient programs than in regular outpatient programs.
VA offers a continuum of substance use rehabilitation services. Mean cost per treatment episode ranges from $2,060 for regular outpatient treatment to $16,693 for treatment in a domiciliary. VA targets inpatient treatment to those with the most severe psychiatric problems, and intensive outpatient care to those with more severe substance use problems, but there is considerable overlap in the severity of illness of patients seen in different settings.
Policy makers should consider the trade-off between cost and outcomes in choosing the mix and quantity of substance use rehabilitation services and in setting the criteria for matching patients to type of treatment.