PharmacoEconomics

, Volume 18, Issue 4, pp 405–413 | Cite as

Cocaine Medications, Cocaine Consumption and Societal Costs

Original Research Article

Abstract

Objective: To estimate the benefits of reduced cocaine consumption in terms of reduced societal costs resulting from the introduction of a medication for cocaine dependence with a small incremental treatment effect.

Study design: Cost-benefit analysis is applied to study the implications of reduced cocaine consumption. A modelling approach extrapolates the magnitude of treatment effects.

Methods: Epidemiological data on cocaine use and consumption as well as economic methods of cost-benefit analysis are utilised. Estimates of societal costs associated with heavy users of cocaine, who are most likely addicted and in need of immediate treatment, are developed using 1995 data.

Main outcome measures and results: In the first analysis, a postulated 1% reduction in consumption of cocaine among heavy users is examined to approximate a small treatment effect, resulting in a minimal consumption benefit. It is estimated that such a reduction would be valued at $US259 million. The cost-benefit analysis indicated that a cocaine medication with a small treatment effect (10 percentage point increase in abstinence rates) would result in a benefit to cost ratio in the range of 1.58 to 5.79, depending on prescribing behaviour and type of patient.

Conclusions: Such estimates of the benefits of these small treatment effects are conservative, and they may be biased downwards since the willingness to pay for such a cocaine medication could far exceed the benefit to cost estimation used in this paper. Nevertheless, the substantial benefits found in this paper indicate how important investment in cocaine medication is for public health policy; costs may be reduced with efficient prescribing behaviour. Market and governmental barriers to the utilisation of a cocaine medication could reduce the benefits and increase costs. Clinical trials, cost-effectiveness studies, and cost-benefit studies must be conducted to establish the actual pattern of benefits and costs that could be obtained for an efficacious and effective cocaine medication.

Keywords

Cocaine Drug Abuse Treatment Societal Cost Abstinence Rate Cocaine Abuse 

Notes

Acknowledgements

The author appreciates the helpful comments of Paul Solano, Michael French, Donald Shepard, Jody Sindelar, Robert Battjes, Stephen Zukin, Bennett Fletcher, Frank Vocci, Andrea Baruchin, Joel Egertson, Jerry Flanzer, Carol Cowell and two anonymous referees on an early draft of this paper. I am responsible for all errors.

References

  1. 1.
    Harwood H, Fountain D, Livermore G, and The Lewin Group. The economic costs of alcohol and drug abuse in the United States, 1992. NIH publication no. 98–4327. Rockville (MD): National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998: 1–10 [online]. Available from: URL: www.165.112.78.61 [Accessed 2000 Aug 16]Google Scholar
  2. 2.
    Carroll KM. Manual 1, a cognitive-behavioral approach: treating cocaine addiction. NIH publication no. 98–4308. Bethesda (MD):National Institute on Drug Abuse, 1998 [online].Available from: URL: http://www.nida.nih.gov/txmanuals/cbt/cbt1.html [Accessed 2000 Aug 16]
  3. 3.
    Rydell SP, Everingham SS. Controlling cocaine, supply versus demand programs. Report to the Office of National Drug Control Policy. Santa Monica (CA): RAND Corporation, 1994Google Scholar
  4. 4.
    Rhodes W. Synthetic estimation applied to the prevalence of drug use. J Drug Issues 1993; 23 (2): 297–321Google Scholar
  5. 5.
    Rhodes W. What America’ users spend on illegal drugs, 1988–1993.Washington, DC: Office of National Drug Control Policy, 1995Google Scholar
  6. 6.
    US Congress, Senate Committee on the Judiciary. Hard-core cocaine addicts: measuring-and-fighting-the epidemic. A staff report for the use of the committee on the judiciary, 1990. US Congress, 1990Google Scholar
  7. 7.
    Homer J. A system dynamics model for cocaine prevalence estimation and trend projection. J Drug Issues 1993; 23 (2): 251–79Google Scholar
  8. 8.
    Everingham SC, Rydell CP. Modeling the demand for cocaine. Santa Monica (CA): RAND Corporation, 1994Google Scholar
  9. 9.
    Office of National Drug Control Policy. The National Drug Control Strategy. Washington, DC: Government Printing Office, 1997: 10–1Google Scholar
  10. 10.
    Office of National Drug Policy. The National Drug Control Policy Strategy. Washington, DC: Government Printing Office, 1998Google Scholar
  11. 11.
    Hubbard RL, Craddock SG, Flynn PM, et al. Overview of 1- Year Follow-up Outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997; 11 (4): 261–78CrossRefGoogle Scholar
  12. 12.
    Alterman AI, O’Brien CP, McLellan AT, et al. Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation. J Mental Nervous Dis 1994; 182 (3): 157–63CrossRefGoogle Scholar
  13. 13.
    O’Brien CP, McLellan AT. 1996. Myths about the treatment of addiction. Lancet 1996; 347: 237–40CrossRefGoogle Scholar
  14. 14.
    Office of Applied Studies. Uniform Facility Data Set (UFDS): data for 1996 and 1980–1996. DHHS publication no (SMA) 98–3176.Washington,DC: Substance Abuse and Mental Health Administration, 1996: 52Google Scholar
  15. 15.
    Office of Applied Studies. National admissions to substance abuse treatment services. The Treatment Episode Data Set (TEDS) 1992–1996. DHHS publication no. (SMA) 98–3244. Rockville (MD): Substance Abuse and Mental Health Administration, 1998: 52Google Scholar
  16. 16.
    Cohen J. Statistical power analysis for the behavioral sciences. New York (NY): Academic Press, 1977Google Scholar
  17. 17.
    Hannan T. The benefits and costs of methadone maintenance. Public Policy 1976; 24 (2): 197–226Google Scholar
  18. 18.
    National Institutes of Health. NIH Consensus panel recommends expanding access to and improving methadone treatment programs for heroin addiction [press release]. Rockville (MD): NIH, 1997 Nov 17 [online]. Available from: URL: http://www.nih.gov/news/pr/nov97/od-19.htm [Accessed 2000 Aug 16]

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.National Institute on Drug AbuseBethesdaUSA

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