|June 18, 2004|
Alcohol and Drug Services Study (ADSS) Cost Study
The Alcohol and Drug Services Study (ADSS) was a multi-phase study of substance abuse treatment facilities and clients, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) between 1996 and 1999. Its financial component, the ADSS cost study, aimed to provide national estimates for cost, revenue, counseling activities, and staffing. The ADSS cost study was the first study of treatment costs with validated cost data from a nationally representative sample of substance abuse treatment facilities.1
The ADSS study was administered in three stages.2 Phase I of ADSS surveyed a nationally representative sample of 2,395 treatment facilities by telephone.
Phase II, upon which the ADSS cost study was based, consisted of site visits to a subset of 280 facilities. Facility-level data were collected from in-person interviews with administrators. For each facility, information was obtained on costs, clients served, staffing, and services provided. In addition, client-level data were obtained from a sample of client treatment records. Among the Phase II facilities, 48 offered non-hospital residential treatment, 44 offered outpatient methadone treatment, and 222 offered outpatient treatment (without methadone). Some facilities provided more than one type of care. Facilities with hospital inpatient care only were excluded from Phase II and the cost study.
Phase III consisted of follow-up interviews with clients sampled in Phase II. Phase III data were not used in the cost study.
The ADSS cost study assessed the validity of the data collected in Phase II using automated programs which tested the relationships among client counts, costs, staffing, and other resource and utilization measures. Cost data were verified and refined using call-backs to facilities. Treatment costs were estimated for each type of treatment for 1997.3 The cost study dollar amounts reported here have been adjusted for inflation. Using 1997 as the base year, the medical care services component of the Consumer Price Index was used to inflate costs to 2002 levels.
Cost Per Admission and Cost Per Enrolled Client Day
Cost per admission and cost per client day were calculated by dividing total annual costs by annual admissions and by estimated annual treatment days, respectively. Total annual costs included all costs and expenditures for treatment during a 12-month period. This included explicit costs (direct and indirect facility outlays and operating noncapital expenditures) as well as implicit costs (asset depreciation and the estimated market value of resources used free of charge, such as use of donated space).
The mean cost per admission was highest for outpatient methadone treatment ($7,415) and lowest for outpatient treatment (without methadone) ($1,433) (Table 1).
The mean cost per admission for residential care was $3,840. Since an admission is the start of an episode of care, mean cost per admission represents mean cost per treatment episode.
Non-hospital residential care had the highest mean cost per enrolled client day ($76.13) (Table 2.) The mean cost per enrolled client day was much lower for outpatient methadone and outpatient treatment (without methadone): $12.65 and $11.24, respectively.
Although cost per enrolled client day was lower for outpatient methadone than for non-hospital residential treatment, outpatient methadone had higher costs per admission because clients stayed in outpatient methadone treatment longer, an average of 520 days compared with 45 days for non-hospital residential treatment. Outpatient treatment (without methadone), with an average length of stay of 144 days, had the lowest costs per client day and per admission.
Outpatient costs were also analyzed by the cost per outpatient visit (annual costs divided by estimated outpatient visits).4 The average cost per outpatient visit for outpatient methadone treatment was $17.78, compared with $26.72 per visit for outpatient treatment (without methadone) (Table 2). Outpatient methadone facilities were less likely to offer some of the treatment and support services provided by other facilities.5
Personnel costs comprised the largest component of costs for all types of care. Personnel costs accounted for 79 percent of total costs for outpatient treatment (without methadone), 65 percent for outpatient methadone treatment, and 63 percent for residential treatment (Figure 1). The share attributable to personnel was lower for outpatient methadone and residential treatment because both had proportionally higher levels of administrative, medical, or housing costs than occurred in outpatient treatment (without methadone).
Distributions of personnel costs by staff type varied across types of treatment (Figure 2). For outpatient treatment (without methadone), 71 percent of personnel costs were for counseling staff, compared with only 52 percent for non-hospital residential and 37 percent for outpatient methadone care. Medical staff accounted for 40 percent of personnel costs for outpatient methadone treatment, but only 9 percent for non-hospital residential treatment and 6 percent for outpatient treatment (without methadone).
1 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The ADSS Cost Study: Costs of substance abuse treatment in the specialty sector, Analytic Series A-20, DHHS Publication No. (SMA) 03-3762, Rockville, MD, 2003.
2 See the ADSS methodology report at http://www.oas.samhsa.gov/adss.htm#Methods for more details on the sampling and methodology for ADSS.
3 The ADSS reports, including the full ADSS cost study report, are available at http://www.oas.samhsa.gov/adss.htm.
4 Cost per visit is higher than cost per enrolled day because not every enrolled day in outpatient treatment includes a visit.
5 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Alcohol and Drug Services Study (ADSS): The national substance abuse treatment system: Facilities, clients, services, and staffing. Rockville, MD, 2003.
This page was last updated on May 16, 2008.