Cost-effectiveness of drug interventions: whose values count?

How to use best the few recourses in society to make economic evaluations

Session: 01.02, Tuesday, 09.00-10.30

Raoul Fransen, Rapporteur

Alex Wodak (Australia) opens the session, stating that cost-effectiveness is becoming an increasingly important issue.

Christine Godfrey (Ipswich, UK) reports that economic evaluations involve identifying, measuring, valuing and comparing changes the input (costs) of alternative choices of interventions an their consequences. Change in drug problem rates can effect the user, their families, communities and the wider society. Many existing economic evaluations of drug treatments have only focussed on whether providing additional or new treatments reduce societal costs through reductions in crime, health care costs etc.

She presented the different elements that should be measured and valued if judgments are to be made about the relative value for money of different approaches to minimizing the harm arising from drug misuse. While economic techniques cannot provide all answers they can set out a more explicit framework in which issues of whose values count can be explored.

The types of economic evaluation vary by the way individual effects on quality and quantity of life are measured. Ways of measurement: cost minimization, - effectiveness, - utility and û benefit.

Finally Christine points out that the questions that need to be addressed are: if new programs are worthy of investment, choices need to be made between interventions with same goals and between drug intervention with different goals.

Robert Broadhead (University of Connecticut, USA) reports on community outreach programs in the United States. Specifically a study where the performance of a traditional outreach program and a peer driven intervention that was implemented in medium sized towns. He based comparisons on the number and representativeness of IDUÆs recruited at a site, the effectiveness of HIV-prevention education, compliance with AIDS risk-reduction and recommendations and relative cost. The study was based on 552 first interviews and 190 6-month follow-up interviews, conducted during the first two years of the operation.

In the program the peers are rewarded for educating and being interviewed up to $30.- The system is immune for manipulations.

Both interventions show significant reductions in HIV risk behavior. The findings demonstrate that IDUÆs can play a far more extensive and active role in community outreach efforts than the traditional model allows. The findings also demonstrate that both interventions reduce HIV associated risk behaviors, but the peer-driven interventions reaches a larger and more diverse set of IDUÆs as does so at much less expense.