Developing a utility index for substance abuse: Theory and application

Legislators and health policy decision-makers are often faced with the dilemma of having to allocate scarce resources to competing health care programs. Legislators must allocate limited resources in a manner that will satisfy their constituents, while other health policy decision-makers must allocate resources in a way that will satisfy the payers they represent. Health policy decision-makers should be informed on treatment-effectiveness and the cost-effectiveness of the competing programs. Substance abuse treatment programs often compete for limited resources within the public sector. If treatment effectiveness can be expressed in terms of some common denominator (while costs are expressed in dollars) it is easier to compare different programs for different diseases.;The purpose of this study was to create a utility index that would quantify the quality of life improvements due to substance abuse treatment. A utility index is a ranking and ordering of the significant outcomes related to substance abuse treatment and the values which society attaches to each one. This utility index quantified the quality of life contributions from substance abuse treatment so that a quality adjusted life year (QALY) could be created as an outcome measure. Neither a QALY for substance abuse nor a utility index existed prior to this study. Substance abuse treatment modalities can now be compared to control measures for other diseases using dollars per QALY s as the unit of comparison in cost-effectiveness analyses.;The three major goals of this dissertation were to: (1) Create a utility index using a societal perspective in order to estimate a QALY for substance abuse treatment, which could ultimately be used as an outcome measure in cost-effectiveness analyses (CEA). (2) Quantify the burden that a substance abuser typically has on others in society. This allowed for the measurement of a utility score for others in society affected by the substance abuser. (3) Test the utility index, which was created using data from substance abuse treatment programs.;This dissertation has contributed to the current body of knowledge on substance abuse by creating a utility index which has allowed for the quality of life improvements due to substance abuse treatment for both the individual receiving treatment and for others in society to be valued and quantified. (Abstract shortened by UMI.).