Can the Treatment Services Review be used to estimate the costs of addiction and ancillary services?

Purpose: The economic costs of addiction treatment and ancillary services a re of great interest to substance abuse treatment providers, researchers, a nd policymakers. This paper examines whether a widely used treatment evalua tion instrument, the Treatment Services Review (TSR), can be used to estima te the costs of addiction and ancillary services. Methods: The fifth editio n of the TSR (TSR-5) is carefully reviewed and critiqued for cost estimatio n purposes. Unit cost estimates and sources are presented for most of the s ervice delivery units on the TSR-5, and important missing service measures are identified, A cost analysis method is proposed that is based on data fr om the TSR. Results: A variety of unit cost estimates are offered so that r esearchers and practitioners will understand how this financial information is compiled. However, the investigation determined that the TSR-5 is not c urrently structured for a comprehensive cost analysis of treatment services . The potential benefits and limitations of the TSR-5 as a cost analysis to ol are identified and explained. In addition, recommended changes to the TS R-5 are suggested and described. Implications: Although not originally deve loped for economic evaluation purposes, with some modifications and enhance ments, the TSR is an instrument that is capable of facilitating an economic cost analysis of addiction treatment and ancillary services. By combining service utilization information from a revised TSR (i.e., TSR-6) with relia ble unit cost estimates for those services, future evaluation studies will be able to provide more standardized estimates of the costs of addiction an d ancillary services for different typos of treatment clients. When joined with outcome data, the TSR-6, along with the proposed cost module, can also be used to determine cost-effectiveness and benefit-cost ratios for subgro ups of patients and treatment components. (C) 2001 Elsevier Science Inc. Al l rights reserved.