Cost/effectiveness analysis of alcoholism and drug abuse treatment programs: the relevance of recidivism and resource absorption.

Cost/effectiveness measures are increasingly being applied to alcoholism and drug abuse treatment programs. Program evaluators usually regard readmissions as inadequate for assessing outcome, and resource absorption is rarely examined; this paper presents the argument that increased attention to recidivism and resource absorption is integral to the program evaluation process. Readmissions formed 53% of admissions to U.S. drug abuse programs, and in alcoholism treatment centers, 4% of the patients accounted for 24% of the detoxications. Problems with assessing cost/effectiveness are associated with duration of treatment, average cost, time span of analyses, quasi-experimental designs, multiple episodes of treatment, "silting up", and extrapolation. Five approaches to dealing with these problems are suggested: analyzing existing program data bases for recidivism and resource absorption, considering recidivism when evaluating programs, tempering clinical enthusiasm with skepticism, matching patients with levels of care appropriate to previous treatment history, and assessing additional benefit derived from increasing amounts of care per patient as part of cost/effectiveness analysis.