Download Cost Benefit Analysis IV

Basic Cost / Benefit Analysis
of Drug Court Client Costs
Prescription Drug Abuse and Overdose Prevention
Rapid Response Drug Task Force
Presented to the Rapid Response Drug Task Force Meeting on January 22, 2013
Research-based Drug Court Results
• Substance Use: Significant reductions in drug relapse
• Crime: Significant reductions in criminal behavior
• Other Psychosocial Outcomes: Participants
experience benefits in other areas of their lives
besides drug use and criminal behavior
*Employment
*Educational
Source: Source: The Multi-Site Adult Drug Court Evaluation: Executive Summary
http://www.urban.org/uploadedpdf/412353-multi-site-adult-drug-court.pdf
*Financial
What Makes Drug Courts Work?
• Role of the Judge
• Role of Other Offender Attitudes
• Role of Court Policies and Practices
Source: The Multi-Site Adult Drug Court Evaluation: Executive Summary
http://www.urban.org/uploadedpdf/412353-multi-site-adult-drug-court.pdf
Drug Courts Save Do$$ars
• Every $1 spent on drug courts yields $2.21 in
savings in the criminal justice system alone
• Approximately 120,000 clients nation-wide
receive
– Help to break the cycle of addiction
– Recidivism
Source: Fact Sheet Drug Courts, May 2011
http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/drug_courts_fact_sheet_5-31-11.pdf
Prevalent Presenting Issues of Drug Court Clients
Not in Ranked Order
• Alcohol addiction
• Prescription drug addiction
• Illicit opioid addiction
Source: Jefferson County Drug Court, 2012
Jefferson County Drug Court Clients, 2002 – Present
Either Completed the Program or were Terminated
• 149 completed the drug court program
– 49 clients attended outpatient treatment only
– 82 clients attended inpatient residential treatment, 28-90 day program
– 14 clients attended medium residential treatment, 4 – 6 months
– 41 clients attended long-term residential treatment, 8 – 12 months
• Some clients attended inpatient treatment programs more than once
• 83 clients were terminated by the drug court program; some died and
others had their cases transferred; 79 clients went to NYS prison
• The 60 new drug court clients are NOT included in this presentation
Source: Jefferson County Drug Court, 2012
Drug Court Cost Per Client
• Drug court cost per client is $5,000
– Pays drug court coordinator’s salary, benefits and
fringes
– Pays for portion of drug court judge’s time
– Pays for drug testing supplies
– Pays for other office supplies
Source: Jefferson County Drug Court, 2012
Approximate Cost Per Client Attending a
12-Month Outpatient Treatment Program
Medicaid Cost
DSS Cost
Private or Self Pay Cost
Assessment: $152
Assessment: $64
Assessment: $80
1 Individual Session: $122
1 Individual Session: $64
1 Individual Session: $80
2 Group Sessions @ $47
p/session x 52 weeks =
$4,888
2 Group Sessions @ $64
p/session x 52 weeks =
$6,656
2 Group Sessions @ $80
p/session x 52 weeks =
$8,320
Total: $5,162 per client
Total: $6,784 per client
Total: $8,480 per client
Source: CREDO Community Center for the Treatment of Addictions, 2012
Approximate Cost for 149 Clients Attending a
12-Month Outpatient Treatment
2002 - Present
$1,400,000.00
Cost in Dollars
$1,200,000.00
$1,000,000.00
$800,000.00
$600,000.00
$400,000.00
$200,000.00
$-
MEDICAID
DSS
Private or Self Pay
$769,138.00
$1,010,816.00
$1,263,520.00
Source: CREDO Community Center for the Treatment of Addictions, 2012; MEDICAID: $5,162 per Client; $DSS: $6,784 per Client; Private or Self Pay
Cost per Client: $8,480
Approximate Calculated Cost of Clients Who Attended
Inpatient Treatment, 2002 - Present
$600,000.00
$500,000.00
Cost
$400,000.00
$300,000.00
$200,000.00
$100,000.00
$82 Clients, 28-90 Days,
28 days
14 Clients, 4 - 6 Months,
120 days
41 Clients, 8-12 Months,
240 days
Total
$84,952.00
$62,160.00
$364,080.00
$511,192.00
Source: CREDO Community Center for the Treatment of Addictions, 2012; Calculated at Public Assistance Allowance of $957 per Month plus $158
Allowance for Personal Needs = $1,115 per Client per Month , $37.17 Per Day per Client, Using the Lowest Length of Stay
Clients Who Were Terminated by Drug Court
and Went into NYS Prison, 2002 - Present
• To date, 83 clients have been terminated by drug court
• Approximately 79 clients were transferred to NYS
prison
• Average cost to house a NYS prisoner for 1 year is
$50,000
• Sentences range from 1-3 years up to 4.5 – 9 years
• For the purpose of this presentation, the average stay
is calculated at 3 years
Source: Jefferson County Drug Court, 2012
Approximate Total Cost, 232 Clients
(149 Completed and 83 Terminated) * 2002 - Present
232 Clients, Outpatient, $5,162 p/Client,
MEDICAID Rate
$1,197,584
232 Clients, Drug Court Cost, $5,000
$1,160,000
82 Clients, 28-90 Days Inpatient, 28 Days
$37 p/Day
$84,952
14 Clients, 4 – 6 Months Inpatient, 120 Days
$37 p/Day
$62,160
41 Clients, 8-12 Months, 240 Days
$37 p/Day
79 Clients, NYS Prison, $50,000 p/Year, 3 Years
$364,080
$11,850,000
•MEDICAID Rate, $5,162 p/Client; Public Assistance Allowance, $1,115 p/Month ($957 PA Allowance plus$158 Personal Needs Allowance); Lowest Length of
Stay, NYS Prison at $50,000 p/Year, $150,000 for 3 Years was Used to Calculate Cost
Medication-supported Treatment
(MST)
• Methodone – opioid agonist – diversion potential
• Suboxone – partial opioid agonist – diversion
potential
• Vivitrol – opioid and alcohol antagonist – no
diversion potential
– Long-term drug users whose livers are injured may not
be eligible for Vivitrol
Source: SAMHSA. (2012). An Introduction to Extended-Release Injectable Naltrexone for the Treatment of Opioid Dependence. Volume 11, Issue 1. HHS
Publication No. (SMA) 12-4682.
Benefits of Vivitrol
• Non-opiate based, non-addicting opioid antagonist
• No euphoria because it does not stimulate the
dopamine reward pathway
• No street value
• No diversion potential
• NOTE: For the purpose of the cost calculation,
$1,000 per shot was used
Source: Alkermes, “Mechanism of Action,” 2012
Vivitrol Is Not a Magic Bullet
• Patients have better treatment outcomes when Vivitrol is
combined with
– Behavioral therapy
– Relapse prevention strategies
– Self-help groups
– Vivitrol has not been studied as a sole component of
treatment
Source: SAMHSA. (2012). An Introduction to Extended-Release Injectable Naltrexone for the Treatment of Opioid Dependence. Volume 11, Issue 1.
HHS Publication No. (SMA) 12-4682.
Projected Cost of Five (5) Drug Court Clients*
with Vivitrol Medication-supported Treatment
$120,000.00
$100,000.00
$80,000.00
$60,000.00
$40,000.00
$20,000.00
$-
12 Months Outpatient
12 Vivitrol Shots@$1000
Court Cost
Total
5 Drug Court Clients
$25,810.00
$60,000.00
$25,000.00
$110,810.00
*MEDICAID Rate, $5,162 per Client Used to Calculate Outpatient Cost
A Modest Proposal (Not Jonathan Swift’s)
Voluntary Participation of 5 Drug Court Clients*
$900,000.00
$800,000.00
$700,000.00
$600,000.00
$500,000.00
$400,000.00
$300,000.00
$200,000.00
$100,000.00
$5 Drug Court Clients, MST
Vivitrol
5 Clients 28-90 Days, 28
Days
5 Clients, NYS Prison, 3
Years
* Each cost category includes $25,810 for Outpatient and $25,000 for Court Cost for 5 Clients
$110,810.00
$55,990.00
$800,810.00
Ancillary Costs of Addiction
Crimes ancillary to people’s prescription drug and/or
illicit drug addictions
– Drug-induced crimes
• Theft
• Robbery
• Vandalism
• Drunk and/or Impaired Driving
• Domestic Abuse
–Spousal Abuse
–Child Abuse
Source: Battling Prescription Drugs and Alcohol: Another Weapon, Sheriff James M. Cummings, Barnstable County, Massachusetts, April 2012,
http://www.bsheriff.net/column30.html
Limitations of the Data
• The breakdown of clients for Medicaid, DSS, and Private or
Self Pay is not known.
• The breakdown of how many clients went inpatient more
than once and their respective lengths of stay is not known.
• For clients who went inpatient the lowest number of days
or months was used to calculate the approximate cost.
• For clients who went to NYS prison, the average sentence
was calculated at 3 years.
(Source: Jefferson County Drug Court, 2012)
Limitations of Data, cont’d
• Some prisoners are released before the average 3-year sentence is
completed, but that number is not known.
• For cost analysis, only CREDO’s outpatient fee scale was used.
• Inpatient costs were at the per day Public Assistance Allowance,
$1,115 ($957 plus $158 Personal Needs Allowance).
• Cost of detoxification for clients who may have required it is not
known.
• 83 drug court clients were terminated but it is not known at which
point that termination occurred. Therefore, cost of the 83 clients
for 12 months outpatient treatment and court cost are included in
the analysis.
Conclusion
• Drug Courts reduce recidivism.
• Drug Courts reduce substance abuse.
• Introduction of medication-supported treatment
can be an effective tool for motivated clients.
• Vivitrol has the potential to save considerable
Jefferson County and NYS monies.
Questions, Concerns, Suggestions