Empirical estimation of drug treatment costs in Portugal

Transcription

1 Empirical estimation of drug treatment costs in Portugal Ricardo Gonçalves, Universidade Católica Portuguesa (Porto) Domingos Duran, SICAD Sofia N. Silva, Universidade Católica Portuguesa (Porto) Fátima Trigueiros, SICAD Lisbon Addictions 2015 Conference Lisbon, 23-25th September 2015

2 Introduction Treating drug abuse and addiction is costly exactly how costly? particularly relevant question when treatment is publicly funded (as is the case of Portugal) Portugal s National Strategy for the Fight Against Drugs (NSFAD), approved in 1999, is rooted in a health-oriented rationale introduced a significant change in the allocation of treatment costs integrated treatment approach: various treatment-related structures (e.g. prevention, risk and harm reduction, treatment and social reintegration) integrated and their costs supported and registered by a single public institute (IDT) this presents a good opportunity to carry out a deeper analysis of drug treatment costs

3 Data Data provided by SICAD, for the years 2011 and 2012 costs of each treatment team, broken down by type of expenditure number of events (and their characteristics) for each team number and type of staff allocated to each treatment team

4 Methodology Econometric estimation of a flexible cost function (translog) for treatment of addictive behaviour in Portugal in Economics, a cost function establishes a relationship between input prices and output levels with the total production costs because different treatment teams have different output mixes, this tecnique allows us to infer average costs for each output includes all possible interactions between input prices and output levels two inputs: labour and other costs labour costs calculated based on the composition (by staff type and respective salary) of each treatment team we have estimated the cost function jointly with the cost share equations in order to improve the quality of the estimation

5 Methodology Did not want to define, a priori, what would be the outputs of each treatment team model 1: activity based outputs Prevention, Harm reduction, Social rehabilitation, Treatment, Other model 2: substance based outputs (broad categories) Alcohol, Drugs, Tobacco, Other model 3: substance based outputs (with breakdown by drug type) Alcohol, [Opiates, Stimulants, Hallucinogens, Cannabis, Other drugs], Tobacco, Other

6 Summary statistics Variable No. Obs. Mean St. Dev. Min. Max. Total costs 83 1,170, ,894 22,594 4,649,957 Number of staff Number of events 83 10,879 6,338 1,273 31,983 Number of treated individuals ,611 Average event duration Prevention Harm reduction ,070 Model 1 outputs Social rehabilitation 83 1,452 1, ,137 Treatment 83 9,157 5, ,786 Other Model 2 outputs Model 3 outputs Alcohol 83 1, ,382 Drugs 83 9,548 5,967 1,200 29,334 Tobacco Other ,273 Alcohol 83 1, ,382 Opiates 83 6,478 3, ,910 Stimulants ,786 Hallucinogens Cannabis ,081 Other drugs 83 2,309 2, ,372 Tobacco Other ,273

7 Results Results are preliminary and further work is clearly necessary used a (simplified) homothetic translog cost function, excluding 8 outliers from analysis broadly speaking, diffi culty in finding meaningful relationships between output and cost levels could be due to significant heterogeneity between treatment teams or need for further variables which explain cost differences models 1 and 2 are the most promising in terms of overall results

8 Results Model 1: Average incremental cost (marginal cost) of: Prevention: ( 1.206) Treatment: 134 ( 164) Model 2: Average incremental cost (marginal cost) of: Drugs: 128 ( 93) Model 3: Average incremental cost (marginal cost) of: Stimulants: ( 1.913)

9 Conclusion Methodology allows for empirical estimation of drug treatment costs relevant from a policy viewpoint further work is necessary to fine-tune data/variables used Methodology also allows analysis of economies of scale or scope in treatment network this allows for a better understanding of the adequacy of the treatment network currently in place very relevant also from a policy viewpoint