Patient and program costs, and outcomes, of including gender-sensitive services in intensive inpatient programs for substance use

Abstract

Gender-sensitive services (GSS) attempt to make substance use treatment better for women, but at what cost and with what results? We sought answers to these questions in a federally-funded study by measuring separately the patient and provider costs of adding GSS, outcomes, and cost-outcome relationships for 12 mixed-gender intensive inpatient programs (IIP) that varied in amounts and types of GSS. GSS costs to female inpatients included time devoted to GSS and expenses for care of dependents while in the IIP. GSS costs to providers included time spent with patients, indirect services, treatment facilities, equipment, and materials. Offering more GSS was expected to consume more patient and provider resources. Offering more GSS also was expected to enhance outcomes and cost-outcome relationships. We found that average GSS costs to patients at the IIPs were $585 ($515 to $656) per patient. Average GSS costs to providers at the IIPs were $344 ($42 to $544) per patient. GSS costs to patients significantly exceeded GSS costs to providers. Contrary to previous research, offering more GSS services to patients did not result in significantly higher costs to patients or providers. IIPs offering more GSS may have delivered fewer traditional services, but this did not significantly affect outcomes, i.e., days until returning to another substance use treatment. In fact, median cost-outcome for these IIPs was a promising 35 treatment-free days, i.e., over a month, per $100 of GSS resources used by patients and providers.

Treatment outcome and readmission risk among women in women-only versus mixed-gender drug treatment programs in Chile

“…For example, Hansen et al argue that readmission overcomes the difficulties of using measures based on self-reported data such as the definition of treatment goals and experiencing return to substance use (Hansen et al, 2020). Other authors have proposed nuances for interpreting readmission that can certainly apply to our results (Hornack & Yates, 2017;Hser et al, 2011). Readmission may be interpreted as a positive event if the readmission results from a woman's increased awareness of her need to minimize drug exposure and skills development that has resulted in efficiently using health care services (Almeida et al, 2018;Vazquez et al, 2015).…”

Cost-inclusive research on health psychology interventions: Why, how, and what next.

“…CIR does much the same with a Resources × Activities table. Called Activity-Based Costing (ABC) by accountants (Cidav et al, 2020), these tables have been reported in CIR since the 1970s (Carter & Newman, 1976; e.g., Hornack & Yates, 2017). By reporting in separate Resources × Activities table cells the (a) type of resource used, (b) amount of that resource used, (c) unit cost for the resource, and (d) resulting monetary value of the resource, researchers empower readers to develop their own budgets for their own sites and eras even if unit costs differ markedly.…”

Research on Improving Outcomes and Reducing Costs of Psychological Interventions: Toward Delivering the Best to the Most for the Least

“…Similarly, psychologists can and sometimes have measured the amounts of resources consumed in the treatment of different clients and aggregated those amounts into mean or median costs for multiple clients receiving similar interventions (e.g., French et al 2018, Sava et al 2009. Multivariate statistical analyses used by psychologists for decades to compare the effectiveness of alternative interventions also have been used to compare the costs of alternative interventions (see Yates 1996; see also, e.g., Hornack & Yates 2017).…”