Skip to main content

Table 3 Studies that reported substance use disorders

From: The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review

Studies considering costs and effects of substance abuse
Dennis (2004) [29]   Costs intervention and comparators (per episode of care per patient) (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)
 In trial 1 MET/CBT 5,MET/CBT 12 and FSN were compared. In trial 2 MET/CBT 5, ACRA and MDFT were compared. Costs were collected with a program (DATCAP) which yields estimates such as the total annual opportunity cost of treatment and the labor cost per client.
Difference cost
 The difference in costs were not showed in this study. However, it was showed that the differences were significant.
 MET/CBT 5 (trial 1):
 € 1,226
 MET/CBT 12 (trial 1):
 € 1,305
 FSN (trial 1):
 € 3,576
MET/CBT 5 (trial 2):
€1,716
ACRA (trial 2):
€ 1,551
MDFT (trial 2):
€ 2,205
  Effects intervention and comparators (per patient) (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT) Difference effects
   Met CBT 5 (trial 1)
 Days of abstinence: 269
 Recovery*: 28 %
 Met CBT 12 (trial 1)
 Days of abstinence: 256
 Recovery: 17 %
 MET FSN (trial 1)
 Days of abstinence: 260
 Recovery: 22 %
 *Recovery is defined as having no use or abuse dependence problems and living in the community
Met CBT 5 (trial 2)
Days of abstinence: 251
Recovery: 23 %
ACRA (trial 2)
Days of abstinence: 265
Recovery: 34 %
MDFT (trial 2)
Days of abstinence: 257
Recovery: 19 %
 The difference in effects were not showed in this study However it was showed that the difference was not significant.
Results Cost per day of abstinence:
 Met CBT5 (trial 1): € 541
 Met CBT 12: € 677
 Met FSN: € 1,667
Costs per person in recovery
 Met CBT5 (trial 1): € 4,360
 Met CBT 12: € 41,172
 Met FSN: € 16,651
Cost per days of abstinence:
 MET/CBT5 (trial 2): € 991
 ACRA: € 729
 MDFT: € 1,143
Costs per person in recovery
 MET/CBT5 (trial 2): € 7,337
 ACRA: € 4,913
 MDFT: € 12,970
French (2008) [25]   Costs intervention per patient (FFT, Joint and CBT)
 FFT:
 Treatment costs: € 1,817
 Joint:
 treatment costs: € 2,847
 CBT:
 Treatment costs: € 1.439
Costs comparator per patient (Group)
 Group:
 Treatment costs: € 990
Difference costs
 The difference in costs were not showed in this study
Effects intervention per patient (FFT, Joint and CBT)
 FFT:  % days marijuana use 4 months: 25.3
 %of days marijuana use 7 months:39.8
 YSR delinquency score 4 months: 8.2
 YSR delinquency score 7 months:9.2
 Joint
 % of days of marijuana use 4 months: 38.1
 marijuana use 7 months:35.4
 YSR delinquency score 4 months: 9.1
 YSR delinquency score 7 months:8.5
 CBT % of days marijuana use 4 months: 50.6
 % of days marijuana use 7 months:51.8 YSR delinquency score 4 months: 10.2
 YSR delinquency score 7 months:10.4
Effects comparator per patient (Group)
 Group
 % of days of marijuana use 4 months: 54.8
 marijuana use 7 months: 40.7
 YSR delinquency score 4 months: 9.5
 lYSR delinuency score 7 months: 9.4
Difference effects with regression model:
 FFT versus group:
 % days marijuana use after 4 months: −20.11*
 % days marijuana use after 7 months: 4.87
 YSR delinquency score 4 months: −0.60
 YSR delinquency score 7 months: 0.15
 CBT versus group
 % days marijuana use after 4 months: 4.76
 % days marijuana use after 7 months: 18.27
 YSR delinquency score 4 months: 0.38
 YSR delinquency score 7 months: 0.42
 Joint versus group
 % days marijuana use after 4 months: −14.86
 % days marijuana use after 7 months “-2.00
 YSR delinquency score 4 months: −0.50
 YSR delinquency score 7 months: −1.50
Joint versus group
Delinquency score after 4 months: −0.50
Delinquency score after 7 months: −1.50
Results Group therapy was most cost-effective, none of the other therapies were significantly different in effect compared to group therapy. So the intervention with the lowest costs was considered to be most cost-effective.
Sheidow (2012) [27]   Costs Intervention (DC, DC + MST, DC + MST + CM)
 Treatment costs DC: € 9,083
 Treatment costs DC + MST: € 12,369
 Treatment costs DC + MST + CM: € 12,859
Costs comparator (FC)
 Treatment costs FC:
 € 3,679
Difference costs:
 The difference in costs were not shown in this study
Effects intervention (DC, DC + MST, DC + MST + CM)
 DC
 Marijuana use (days): −16.65
 Polydrug use (days): 1.41
 Alcohol use (days): 0.49
 Heavy alcohol use (days): 0.86
 SRD status offenses (incidents): −7.24
 SRD Theft (incidents): −3.28
 SRD crimes against persons (incidents): −2.69
 DC ± MST
 Marijuana use (days): −30,17
 Polydrug use (days): :-1.11
 Alcohol use (days): 0.27
 Heavy alcohol use (days): −0.45
 SRD status offenses (incidents): −11.11
 SRD Theft (incidents): −2.79
 SRD crimes against persons (incidents): −3.90
 DC ± MST ± CM
 Marijuana use (days): −27.86
 Polydrug use (days): −6.76
 Alcohol use (days): −7.56
 Heavy alcohol use (days): −4.13
 SRD status offenses (incidents): −10.38
 SRD Theft (incidents): −3.19
 SRD crimes against persons (incidents): −2.4
Effects comparator (FC)
 Marijuana use (days): −15,43
 Polydrug use (days): 2.27
 Alcohol use (days): 2.97
 Heavy alcohol use (days): 0.76
 SRD status offenses (incidents): 9.22
 SRD Theft (incidents): −5.54
 SRD crimes against persons (incidents): 0.49
Difference effects:
 The difference in effects were not showed in this study
Results ACERS were calculated; average costs/ difference between mean incidents before and after treatment (negative means inefficient)
  FC DC DC + MST DC + MST + CM
Marijuana use:
Polydrug use:
Alcohol use:
Heavy alcohol use:
SRD status offenses:
SRD theft:
SRD crimes against persons:
€ 238 (215–262)
€ −1,619 (−8,8839–5,601)
€ −,1,239 (−6,546–5,601)
€ −4,857 (−10,632–918)
€ −400 (−1,206–398)
€ 663 (428–899)
€ −7,588 (−10,667–4,510)
€ 545 (474–617)
€ −6,425 (−27,541–14,692)
€ −18,814 (−42,034–4,405)
€ −10,535 (−28,804–7,733)
€ 1,254 (1,132–1,376)
€ 2,773 (−2.441–7,987)
€ 3,377 (2,976–3,777)
€ 410 (377–442)
€ 11,209 (−3,757–26,175)
€ −44,838 (−61,014–28,662)
€ 27,592 (−14,636–69,821)
€ 1,114 (907–1,321)
€ 4,428 (−1,224–10,081)
€ 3,175 (236–6,123)
€ 461 (434–488)
€ 1,912 (1,624–2,182)
€ 1,699 (1,486–1,912)
€ 3,109 (1,708–4,511)
€ 1,239 (1,009–1,496)
€ 4,032 (1,204–6,859)
€ 5,346 (4,723–5,968)
Studies considering costs and benefits of substance abuse
Schoenwald (1996) [32] Costs interventions (MST)
 Mental health outpatient (total): €4,242
 Mental health day treatment (total): € 5,423
 Mental health residential treatment (total): €6,899
 Psychiatric inpatient (total): €15,752
 Psychiatric emergency room (total): €1,150
 Substance abuse outpatient (total): € 2,001
 Substance abuse residential treatment (total): €3,450
 Substance abuse inpatient (total): € 16,098
 Marine Institute day treatment (total): € 18,926
 Marine Institute residential treatment (total): € 3,036
 Treatment costs: € 266,516
Costs comparator (CAU)
 Mental health outpatient (total): € 19,075
 Mental health day treatment (total): € 1,118
 Mental health residential treatment (total): €0
 Psychiatric inpatient (total): €18,513
 Psychiatric emergency room (total): €3,450
 Substance abuse outpatient (total): € 20,272
 Substance abuse residential treatment (total): €43,695
 Substance abuse inpatient (total): €93,771
 Marine Institute day treatment (total): €28,618
 Marine Institute residential treatment (total): €0
Benefits interventions
Incarceration days: €65,427
Benefits CAU
Incarceration days: €120,851
  Results MST: Total costs (costs + benefit) with incarceration = €408,919 and the total costs (costs + benefit) with incarceration per youth = €6,930
CAU: Total costs (costs + benefit) with incarceration = € 335,845 and the costs (costs + benefit) per youth = €5,693.
Difference in total between groups = €1,019
French (2003) [22] Costs interventions (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT) Benefits interventions (MET/CBT 5, MET/CBT 12, FSN, ACRA, MDFT)
 Treatment costs were measured  Health service utilization; Outpatient clinic/doctor’s office visit
 Days bothered by health/medical problem
 Substance-absue treatment utilization; Days in detoxification program; Day in inpatient treatment program; Day in long-term residential program; Intensive outpatient program visits; Regular outpatient program visits
 Education and employment; Days missed at school or training; Personal income; Days stressful for parents
 Day missed of work or school by parent
 Criminal activity; Arrests; Day on probation; Days on parole; Days in prison/jail; Days in juvenile detention
 Incremental arm:
 MET/CBT5:€ 1,226
 MET/CBT12: € 1,305
 FSN: € 3,576
 Alternative arm:
 MET/CBT5: € 1,716
 ACRA: € 1,551
 MDFT: € 2,216
 Incremental arm:
 MET/CBT5
 Baseline € 2,553
 3 months: € 2,133
 6 months: € 1,671
 9 months: € 945
 12 months: € 1,217
 MET/CBT12
 Baseline: € 2,179
 3 months: € 2,433
 6 months: € 828
 9 months: € 1,431
 12 months: € 687
 FSN:
 Baseline: € 2,552
 3 months: € 4,525
 6 months: € 1,783
 9 months: € 1,205
 12 months: € 1,726
Alternative arm:
MET/CBT5
Baseline € 2,694
3 months: € 3,587
6 months: € 2,213
9 months: € 2,275
12 months: € 1,907
ACRA
Baseline: € 2,506
3 months: € 3,691
6 months: € 1,748
9 months: € 3,113
12 months: € 3,237
MDFT:
Baseline: € 2,019
3 months: € 3,938
6 months: € 1,467
9 months: € 2,573
12 months: € 2,098
  Results Net economic benefits (benefits + costs) relative to baseline:
3 different models were administred; Model 1: only time dummies for each of the follow-up periods (as treatment conditions were not included, we did not show the results.
Model 2: time dummies and indicator variables for treatment condition.
Model 3: time and treatment variables withan indicator variable for site. The last specification added numerous demographic and environmental controls.
MET/CBT12:
Model 2: € −198 (349)
Model 3: € −171 (346)
Model 4: € −340 (334)
FSN:
Model 2: € 607* (343)
Model 3: € 653 (340)
Model 4: € 250 (333)
*p < 0.1
Acra:
Model 2: € 369 (436)
Model 3: € 530 (430)
Model 4: € 554 (405)
MDFT
Model 2: −€ 61 (441)
Model 3: € 128 (436)
Model 4: € 100 (530)
McCollister (2009) [24]   Costs interventions (DC, DC/MST, DC) Costs comparators (FC) Benefits interventions (DC, DC/MST, DC) Benefits comparators (FC)
Treatment costs Treatment costs  Criminal activity costs according to Self-reported criminal activity (SRD):
 DC:
 € 28.601 (94.314)
 DC/MST:
 €65.640 (240.559)
 DC/MST/CM:
 €80.222 (336.461)
 Self-reported criminal activity (SRD):
 FC: € 206.045 (545.581)
 DC:
 €8,156
 DC/MST:
 €11,547
 DC/MST/CM:
 € 11,547
 FC:
 €3,304
Results After 12 months, total costs relative to FC with multivariate model (intervention costs not incorporated):
DC: € -124,877 (−84,107)
DC/MST: €-117,918 (−82,570)
DC/MST/CM: €140,274 (/79.066)*
All DC conditions generated reduction in crime costs, greater than average costs of treatment.
  1. Currency and price year: Sheidow (2004).USD, 1997; Dennis (2004).USD, 1999; French 2008.USD, 1998; Sheidow (2012).USD 2004. When a price year was not stated it was estimated by taking the mean year of the study duration or when not available subtracting 1 from the year of publication of the study
  2. MST multisystemic therapy, Joint combination of individual and family therapy, group skill-focused psycho-education group intervention, CAU care as usual, FSN family support network, MDFT multidimensional family treatment, MET/CBT12 motivational enhancement treatment/cognitive behavior therapy, 12 sessions, MET/CBT5 motivational enhancement treatment/cognitive behavior therapy, 5 sessions, Acra adolescent community reinforcement approach, DC drug court with community services, DC + MST drug court with multisystemic therapy; DC + MST + CM drug court with MST and enhanced with a contingency management programs, FFT functional family therapy, FC family court with community services, ACERS average cost-effectiveness ratios