COSTING SUBSTANCE MISUSE SERVICES

Aims. To develop a methodology for obtaining the detailed costs of dif ferent substance misuse services and illustrate some of the specific p roblems by means of a case study. Design. Data on the resources requir ed, clinical activity, and patient characteristics for one year were c ombined to provide detailed costs for different types of clinical even ts and patients. Setting. The clinical services of a publicly funded a ddiction unit in a large industrial city in the UK. The unit provides for alcohol and other drug misusers mainly on an outpatient basis but with inpatient care. Participants. Over 1500 patients were included in the analysis with 75 per cent being male, and 80 per cent aged betwee n 20 and 49. Nearly half of the clients had alcohol as their main drug of misuse with opiate users being the next largest group. Measurement . Detailed costing by event and patient was possible as the staff type and time taken for each event were routinely recorded. A cost for eac h individual event teas estimated and summed for each individual patie nt to give a cost estimate by patient for the financial year 1992/3. F indings. Core treatment outpatient events had an average cost of pound 48, with new assessments costing pound 87 but these averages hid high variations. The average cost per year for those receiving only outpat ient care was pound 358; it was pound 1857 for those receiving both ou tpatient and inpatient care. Opiate misusers were on average more cost ly than alcohol misusers. The costs were skewed with 10 per cent of pa tients accounting for 56 per cent of the total annual costs. Conclusio ns. Dealing with costs of non attendance, including all resource use, and coping with large individual variations in costs across individual s and intervention types are the main problems in devising cost figure s. Cost data are useful but need to be combined with outcome data if t hey are to be used to improve patient services.