Alcohol and Alcoholism Advance Access originally published online on November 4, 2005
Alcohol and Alcoholism 2006 41(1):84-91; doi:10.1093/alcalc/agh236
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COST AND OUTCOME ANALYSIS OF TWO ALCOHOL DETOXIFICATION SERVICES
1 Centre for Health Economics and 2 Department of Health Sciences, University of York, York, UK, 3 Division of Psychology, Northumbria University, UK, 4 Psychology in Healthcare, Newcastle General Hospital, Newcastle upon Tyne, UK and 5 Tony Ryan Associates Limited, Manchester, UK
* Author to whom correspondence should be addressed at: Centre for Health Economics, University of York, YO10 5DD, York, UK. Tel: 0 1904 321435; Fax: 0 1904 321402; E-mail: sjp22{at}york.ac.uk
(First received 6 April 2005; first reports 15 July 2005; received in revised form 29 July 2005; accepted 17 October 2005)
Aim: To examine the relationship between service use and outcomes (individual and wider consequences) using an economic analysis of a direct-access alcohol detoxification service in Manchester (the Smithfield Centre) and an NHS partial hospitalization programme in Newcastle upon Tyne (Newcastle and North Tyneside Drug and Alcohol Service, Plummer Court). Methods: A total of 145 direct-access admissions to the Smithfield Centre and 77 admissions to Plummer Court completed a battery of questionnaires shortly after intake and were followed up 6 months after discharge. Full economic data at follow-up were available for 54 Smithfield admissions and 49 Plummer Court admissions. Results: Mean total cost of treatment per patient was £1113 at the Smithfield Centre and £1054 at Plummer Court in 2003–04 prices. Comparing the 6 months before treatment with the 6 months before follow-up, social costs fell by £331 on average for each patient at Plummer Court but rose by £1047 for each patient at the Smithfield Centre. When treatment costs and wider social costs were combined, the total cost to society at Smithfield was on average £2159 per patient whilst at Plummer Court it was £723 per patient. Combining the cost of treatment with drinking outcomes yielded a net cost per unit reduction in alcohol consumption of £1.79 at Smithfield and £1.68 at Plummer Court. Conclusions: Both services delivered a flexible needs-based service to very disadvantaged population at a reasonable cost and were associated with statistically significant reductions in drinking. For some patients, there was evidence of public sector resource savings but for others these detoxification services allowed those not previously in contact with services to meet health and social care needs. These patterns of cost through time are more complex than in previous evaluations of less severely dependent patients and difficult to predict from drinking patterns or patient characteristics. More research is required to judge the suitability of generic health state measures commonly in use for health economic evaluations for assessing the short-term outcomes of alcohol treatment.