Health Economics of Drug Addiction Treatments : An European Standpoint

Economics deals with the allocation of scarce resources in a society with unlimited desires. When resources become scarce, people face difficult choices. This general concept holds true in the field of drug addiction treatment as well. Since drug use and its consequences are associated with substantial health problems and social costs in Europe and worldwide, health care and societal costs are central issues in the treatment of drug use. Public program administrators and clinicians have a strong stake in improving effectiveness of health care methods and public health strategies while lowering costs. In addition to improved outcomes from drug use services, payers often demand economic justification prior to the adoption of more costly interventions. A number of addiction interventions have been proved to be effective, but resources for treatment are limited relative to the need. Policymakers, regulators and treatment professionals are continually required to provide more effective treatment interventions while lowering costs. Economic evaluations of drug use problems play an important role in providing that justification based on demonstrable costs and resulting benefits. Through a basic review of the specificities of the key methodological principles of economic evaluation in the field of drug addiction, and a summary of the findings of a major literature review on the area, this paper provides a status report on the health economics of drug use services in Europe. It is also aimed at opening the discussion about the gaps and challenges that Europe is facing in this growing field. The search of the peer-reviewed medical and economics literature in English has identified a series of economic evaluations of drug use treatment published between 2000 and November 2006. Overall, findings indicate that drug addiction treatments result in reductions in drug use, crime and improvements in health and social functioning. Economic evaluations across settings, and populations consistently find positive net economic benefits of drug addiction treatment. The main economic benefits occur from reduced crime and reduction in health care costs. Of the articles keyed out, only a few involved an European authorship and/or data source. These results clearly provides evidence of major gaps in health economics research in the field of drug treatment in Europe, or at least in its success in communicating results. Economic evaluations are complex and costly to design, execute and report, but they are essential if investments in interventions are to be based on demonstrable costs and benefits. Better controlled and designed studies are needed in Europe to determine the long-term economic impact of treatment, and the specific components of treatment that are cost-effective or produce positive economic benefits. Studies with poor research designs, weak measures, and/or small sample sizes must be avoided