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首页> 外文期刊>Journal of Health Services Research & Policy >Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from a national prospective cohort survey
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Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from a national prospective cohort survey

机译：注射和非注射海洛因使用者的犯罪结果和治疗服务费用：来自全国前瞻性队列调查的证据

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Objectives: To assess the incremental cost-effectiveness of drug addiction treatment programmes provided in the UK by the National Health Service and not-for-profit agencies in terms of crime-related outcomes. All costs and crime-related outcomes were implicitly evaluated relative to a 'no treatment' alternative. nnMethods: Longitudinal observational data on a national sample of heroin addicts referred to addiction treatment services throughout England were re-analysed. Predictions from a Poisson random-effects model were used to estimate the incremental effectiveness and cost-effectiveness of treatment programmes. Interaction variables were used to assess whether the injecting of heroin on entry to treatment had an impact on cost-effectiveness. nnResults: The findings rejected the null hypothesis that increasing time in treatment (and therefore treatment cost) has no mean crime prevention effect on clients referred for community-based methadone treatment, treatment delivered within specialist drug dependency units and residential rehabilitation programmes (P < 0.05). However, the size of the cost per unit of effect based on model predictions was sensitive to the exclusion of a small group of outlying observations. The interaction between client injecting status and time in treatment was found to be statistically significant (P < 0.05), with an estimated reduction in treatment cost-effectiveness across all treatment programmes for clients who reported injecting drugs at treatment intake. nnConclusions: Whilst the analyses did not include an evaluation of the effect of treatment programmes on client health and quality of life and stopped short of providing a social weighting for the predicted reduction in crimes, they do offer a useful starting point for establishing the cost-effectiveness of treating heroin addiction. The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services.
机译：目标：评估英国国家卫生服务局和非营利机构在与犯罪有关的结果方面提供的药物成瘾治疗计划的增量成本效益。相对于“不治疗”替代方案，对所有成本和与犯罪相关的结果进行了隐式评估。 nn方法：重新分析了全国性海洛因依赖者全国样本的纵向观察数据，这些样本涉及整个英格兰的成瘾治疗服务。来自泊松随机效应模型的预测被用来估计治疗方案的增量有效性和成本效益。相互作用变量用于评估进入治疗后注射海洛因是否对成本效益产生影响。 nn结果：调查结果否定了零假设：治疗时间的延长（以及治疗费用的增加）对以社区为基础的美沙酮治疗，在专门的药物依赖单位内进行的治疗以及住院康复计划的患者没有预防犯罪的平均效果（P <0.05 ）。但是，基于模型预测的每单位效果成本的大小对于排除一小部分外围观察很敏感。发现患者注射状态和治疗时间之间的相互作用具有统计学意义（P <0.05），并且对于报告在治疗时注射药物的患者，所有治疗方案的治疗成本效益估计有所降低。 nn结论：虽然分析未包括对治疗计划对服务对象健康和生活质量的影响进行评估，并且没有为预计的犯罪减少提供社会权重，但它们确实为确定成本提供了有用的起点-治疗海洛因成瘾的有效性。公共决策者有责任决定预期的犯罪减少是否值得投资大量资源用于治疗服务的重大扩展的机会成本。

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