1. A methodology for an EU cross-country comparison: public expenditure on drug treatment in hospitals
Freya Vander Laenen
STRUCTURED SESSION Costs of drug treatment
Lisbon Addictions 2017, 26/10/2017

2. Structure
Date | Title
Background
Methodology
Results
Discussion

3. 1. Background: why compare EU-countries on PE treatment?
Date | Title
Why a socio-economic study?
Drug use and treatment policy
=> economic burden
=> challenges for public policy ~ austerity
Why a cross-country comparison ?
Learn about PE differences in national policies
Learn where PE differences come from ~ number of drug users in treatment (per capita)? Unit cost of different types of treatment? …?
Learn from other countries

4. Background => Guide decisions (on distribution) ~ public spending
Date | Title
=> Guide decisions (on distribution) ~ public spending
Which (treatment) options?
What is the cost of different (treatment) options?
What would it cost/save were we to change our (treatment) policy?

5. 2. Methodology: what do we need for comparison?
Date | Title
valid cross-national comparison
common conceptual and methodological framework
=> Look for international database(s)
OECD, WHO, EMCDDA, UN, European Medicines Agency, European Centre for Disease Prevention and Control, World Bank
Beware: cross-national descriptive comparison ≠ comparative policy analysis (Ritter et al., 2015)

6. Methodology: what did we find?
Date | Title
One database: Eurostat
Data for hospitals: unit expenditure (cost per hospitalisation day)
Hospital (1) days by primary diagnosis (2) and health care expenditures
(1) Data for general, mental health and specialty hospitals
(2) ‘mental and behavioural disorders due to psychoactive substance use’
*based upon International Statistical Classification of Diseases and Related Health Problems (ICD): Acute intoxication; Harmful use; Dependence syndrome; Withdrawal state
=> Average cost per hospital day x hospital days for treating illegal drug disorders

7. Methodology: limitations
Date | Title
Only 15 EU MS (no data Greece, Ireland, Italy, Malta, UK) – 8 countries incomplete data on hospital days
Only when admission to hospitals
Underestimation: No TC, outpatient, prison treatment, GP, …
Overestimation inpatient hospital – since no distinction inpatient, emergency, outpatient hospital services
Presumption: average cost for one day of e.g. cancer treatment = average cost for one day of SUD treatment
ICD-10 – no distinction licit – illicit => overestimation of illicit
+ > PE for drug use as such
Only primary diagnosis -> multiple diagnoses => possible underestimation of SUD
Acute drunkenness (in alcoholism) "Bad trips" (drugs) Drunkenness NOS Pathological intoxication Trance and possession disorders in psychoactive substance intoxication
Excl.: intoxication meaning poisoning (T36-T50)

8. 3. Results Hospital days & expenditures illegal drug treatment, EU-15, 2012
Date | Title

9. Results of drug treatment PE voor EU-15
Date | Title
Average of EU-15: 5 € per capita or 0,013% of GDP
Large variation across EU member states
Western European countries (e.g. Luxembourg, Austria, Germany): above average of EU-15 ( €/capita and 0.022% % of GDP)
Eastern European countries (e.g. Romania, Lithuania, Bulgaria, Latvia): low hospital expenditures/capita (≤ 0.3 €) and in proportion to the GDP (0.002% of GDP)
Why? E.g. Luxembourg: number of hospital days for drug treatment (30/1000 capita ) + cost per hospital day (1328 €) is high versus e.g. Romania (0,5/1000 capita – 83 €/hospital day)

10. 4. Discussion: what proportion of cost did we find?
Date | Title
Hospital treatment = only part of PE on treatment
Data on outpatient, harm reduction, social reintegration, …
Proportion of patients in inpatient treatment 11 % (2 % France versus 79 % Luxemburg – EMCDDA, 2014)
<-> cost for inpatient opioid detox 168 € - outpatient 7 € (Gossop & Strang, 2000)

11. Discussion: providing context from international databases
Date | Title
TDI: data on number of new clients entering treatment in EU
=> Differences in (use of) types of treatment
Treatment gap/coverage: treatment needs versus treatment offer
no positive correlation number of SUD ~ rate of hospital occupation
=> EMCDDA estimate prevalence rates problem drug users & TDI number of clients in treatment

12. Discussion: providing context from international databases
Date | Title
Eurostat and OECD databases
economic and demographic data
data on GDP, population (per capita PE)
Eurostat data on healthcare expenditure by function (inpatient, outpatient, long-term, medical goods, prevention)
Eurostat data by financing agent (general government, social security, private out-of-pocket)
Mix of public and private health financing => differences in PE
Eastern European countries lower proportion public financing healthcare (e.g. 54 % Bulgaria; 62 % Hungary) <-> Western European (e.g. 83 % Luxemburg, 77 % Germany)
Eurostat: EU statistics on Income and Living Conditions (SILC)
Socio-economic variabeles
Income, poverty, social exclusion, living conditions
What do we need: expenditure by type of health problem

13. Discussion: providing context
Date | Title
Even if no data on PE drug treatment…
… Provide information on drug (treatment) policy, on health care policy, on financing agent, on drug treatment types and services, …
+ explain ≠ countries in (drug) treatment expenditures
+ could be applied to other health problems (+ comparison between)

14. Discussion: providing context
Date | Title
The power of “PE studies in times of austerity”
=> ideally link PE on type of treatment with effect of type of treatment
! EMCDDA Insights - Drug treatment expenditure: a methodological overview – 2017 !