almost no other disease is held to this standard.^37
However, if cost-effectiveness were an essential
factor in determining which medical services to
fund, then screening, interventions and treatment
for addiction certainly would be considered a
good investment.
One study found that the annual benefits in
avoided health care spending (i.e., cost-saving)
per person achieved through substance-related
interventions in 2001 dollars ranged from $634
for brief physician interventions for risky
drinkers to $3,951 for standard residential
addiction treatment; the average annual savings
per person was $1,939 across all interventions.^38
The projected cost to insurers of offering
comprehensive addiction treatment benefits also
is modest. According to a 1999 study, the cost
of providing managed,* comprehensive†
addiction treatment benefits with low co-
payments‡ and no annual limits was $5.11 per
member in 1996-1997.^39 Adding managed,
unlimited addiction treatment benefits to a plan
that previously did not offer addiction treatment
benefits would increase costs§ only by an
estimated 0.3 percent.** 40 In 2001, the
Congressional Budget Office estimated that
mandating parity for mental health and addiction
treatment benefits would increase group health
insurance premiums by 0.9 percent initially and
by 0.4 percent in total after accounting for the
market-driven responses of health plans,
employers and workers to the higher
premiums.†† 41 Studies of the effect of mandated
parity in Federal Employee Health Benefit Plans
have concluded that total plan spending per
- Benefits carved out and provided by a large
managed behavioral health care organization.
† Including outpatient, intensive outpatient, inpatient
and residential treatment.
‡ $10 or less.
§ Costs include payments to providers; administrative
fees and profits are not included.
** Assuming annual Health Maintenance
Organization (HMO) insurance premiums of $1,500
per member.
†† Market-driven responses include: reductions in
employers offering and employees enrolling in
employer-sponsored insurance, changes in the types
of plan offerings and reductions in scope of benefits.
member did not increase significantly while out
of pocket expenses for those who received
treatment benefits declined.^42Because cost-effectiveness research to date has
for the most part focused on the cost savings of
providing a particular service within a particular
population, it is not yet possible to generate an
overall estimate of the potential cost savings of
screening all patients for all forms of risky
substance use and providing appropriate
interventions, or for assessing the need for
treatment and providing these services.
However, as the following examples reveal, the
opportunity for cost savings is substantial.Screening and Early Intervention‡‡
Cost-benefit studies of screening and brief
interventions for tobacco and alcohol use among
adults and pregnant women have demonstrated a
range of potential costs savings.^43 Numerous
studies have demonstrated that medical costs for
patients with addiction increase significantly as
these patients age,^44 implying that the greatest
cost savings can be achieved by early
intervention and treatment.§§ 45 In the health
care field, treatment costs of up to $50,000 for
each year of life saved are considered to be a
worthwhile investment in health (i.e., cost
effective); in specialty care, such as cancer,
treatment costs of up to $200,000 may be
considered cost effective.^46Smoking. Smoking cessation programs yield
positive health outcomes at the low cost of
$5,000 per healthy year gained*** 47 compared to
$56,200 per year for Aspirin and statin therapy‡‡ Research is presented related to screening and
interventions for smoking and risky alcohol use.
Comparable research related to other drug use is not
available.
§§ Cost-benefit studies calculate the total cost savings
that result from providing treatment (sometimes
called return on investment); whereas cost-
effectiveness studies determine the treatment costs of
extending a patient’s life by one year, or per quality-
adjusted life year (QALY), a year of perfect health.
*** Cost effectiveness as measured by costs minus
savings for each year of healthy life attributable to
the intervention.