Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 11, Issue 1, 2008. Pages: 27-32
Published Online: 25 Mar 2008

Costs of Day Hospital and Community Residential Chemical Dependency Treatment

Lee Ann Kaskutas,^*1 Silvana K. Zavala,² Sujaya Parthasarathy,³ Jane Witbrodt⁴

¹Dr.P.H., Senior Scientist, Alcohol Research Group at the Public Health Institute; Associate Adjunct Professor, School of Public Health, University of California Berkeley, Berkeley, CA, USA
²M.S., Senior Research Associate, Health Economics Research Group, University of Miami, FL, USA
³PhD, Health Economist and Senior Data Consultant, Kaiser Permanente Division of Research, Oakland, CA, USA
⁴M.P.H., Senior Research Associate, Alcohol Research Group at the Public Health Institute, Emerylle, CA, USA

* Correspondence to: Dr. Lee Ann Kaskutas, Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010.
Tel.: +1-510-597 3456
Fax: +1-510-985 6459
E-mail: LKASKUTAS@ARG.ORG

Source of Funding: National Institute on Drug Abuse, R01 DA 12297.

Abstract

Patient placement criteria developed by ASAM have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher severity. A recent randomized clinical trial found similar outcomes at residential and day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes were delivered with comparable costs. Cost data were collected using the DATCAP. Average costs per week were $575 for day hospital and $370 for residential. Lengths of stay at residential were significantly longer than at day hospital. Because of longer stays, residential per-episode costs were significantly higher overall and among non-Whites (marginally higher among men). These longer residential stays in the sample overall and for non-White clients came at higher costs but did not lead to higher abstinence rates. Women and whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential.

Background: Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs.

Aims: This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum.

Method: This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects.

Results: Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was $575 per week at day hospital, versus $370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men).

Discussion: These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients.

Conclusion: Outcomes and costs at residential versus day hospital programs were similar for women and for Whites. For non-Whites, and marginally for men, a preference for residential care would appear to come at a higher cost.

Implications for Health Care Provision and Use: Lengths of stay in residential treatment were significantly longer than in day hospital, but costs per week were lower. Women and Whites appear to be equally well-served in residential and day hospital programs, with no significant cost differential. Provision of residential treatment for non-Whites may be more costly than day hospital, because their residential stays are likely to be 3 times longer than they would be if treated in day hospital. For men, residential care will be marginally more costly.

Implications for Health Policy Formulation: Residential treatment appears to represent a cost-effective alternative to day hospital for female and White clients with severe alcohol and drug problems who are not at environmental risk.

Implications for Further Research: The much shorter stays in day hospital than at residential among non-Whites highlight the need for research to better understand how to best meet the needs and preferences of non-White clients when considering both costs and outcomes.

Received 31 July 2007; accepted 19 January 2008