Changes in Quality of Life for Pregnant Women in Substance User Treatment: Developing a Quality of Life Index for the Addictions

Abstract

Using preference weights from a community sample, items from the Addiction Severity Index (ASI) were converted into a quality of life index (QOLI) and used to compare the cost-effectiveness of five addiction treatment modalities for pregnant women. Methods: Interviews using the time trade-off methodology were conducted with 143 members of Massachusetts local health planning boards to determine preference weights for different health states resulting from active addiction. A multi-attribute utility formula was used to convert these seven preference weighted scores into a single QOLI. To apply the QOLI, these preference weights were combined with the number of problem days reported in each ASI domain by a sample of 439 pregnant women in MA in five treatment modalities, 1992–1996. Results: Starting at 10 years with an addiction problem, board members indicated that they would give up between 0.83 and 3.96 years to avoid the problems in one domain caused by addiction. The average QOLI was 0.68 at intake but increased by 0.19 points by 6-month follow-up to 0.87. All five treatment groups showed notable improvement in their quality of life. Mean improvements ranged from a high of 0.23 QOLIs for clients who received both residential and outpatient treatment to a low of 0.16 for clients who received only detoxification. Treatment costs ranged from $10,187 for residential and outpatient combined to $2,535 for detoxification only, with costs per QOLI ranging from $14,912 to $44,291. Conclusions: Although this QOLI could benefit from further refinement and development, it showed promise as a single outcome measure for CEAs in the chemical dependency field. This QOLI was sensitive enough to distinguish between the treatment groups, it correlated well with other outcome measures and can be easily converted from the ASI using spreadsheet software and a simple formula.

Keywords:

• cost-effectiveness analysis
• drug exposure
• health states
• quality of life

Additional information

Notes on contributors

Marilyn Daley

Marilyn Daley, Ph.D., is a Senior Research Associate at the Schneider Institute for Health Policy at The Heller School for Social Policy and Management at Brandeis University in Waltham, Massachusetts. With 15 years of experience in addictions research, her work has focused on enhancing the effectiveness and availability of treatment for high-risk populations including pregnant women, drug-involved offenders and the dual-diagnosed. Having received specialized training in health economics through a fellowship from the National Institute of Mental Health, Dr. Daley has expertise in cost-effectiveness analysis, econometrics and cost of illness/quality of life studies. Prior to receiving her Ph.D in Social Policy from the Heller Graduate School in 2000, Dr. Daley conducted survey research and program evaluation on behalf of the Massachusetts Department of Public Health, Bureau of Substance Abuse Services (BSAS). While at BSAS, she was research director for the Mothers Project, part of a national investigation into the costs and effectiveness of alternative treatment programs for pregnant women. Since coming to Brandeis, she has completed an evaluation of Medicaid managed behavioral health care on the quality of treatment for racial minority groups and a cost-effectiveness analysis of substance abuse treatment programs in Connecticut prisons. Dr. Daley is currently directing data collection and analysis for a national survey of physician experiences with Buprenorphine. Her articles have recently appeared in Health Services Research, the Journal of Substance Abuse Treatment and the Journal of Offender Rehabilitation.

Donald S. Shepard

Donald S. Shepard, Ph.D., is Professor at the Schneider Institute for Health Policy at the Heller School, Brandeis University, Waltham, Massachusetts, USA. Director of the Institute's Cost-effectiveness Workgroup, he is a health economist concerned with health problems of both the United States and developing countries. His major concentrations are cost and cost-effectiveness analysis in health, and health financing. Particularly interested in the cost-effectiveness of new technologies, he is a member of Board of Councilors for the Pediatric Dengue Vaccine Institute and the Board of Scientific Advisors of the Sabin Vaccine Institute, both dedicated to new and improved vaccines. He served as a member of peer review “study section” that reviews grant applications to the National Institutes of Health in health services research for scientific merit. With funding from the Massachusetts Division of Medical Assistance and the National Institutes of Health, he was Principal Investigator (PI) or Co-PI of the evaluation of a restructuring of mental health and substance abuse services in the state. He is the lead evaluator of two national demonstrations for the Medicare Program. Prof. Shepard's research focuses on the cost-effectiveness of alternative approaches to substance abuse treatment, lifestyle modification, prescription drug coverage, and AIDS care. He co-authored the 1976 paper that first coined the acronym QALYs (for Quality Adjusted Life Years) that has become an international standard for outcomes in cost-effectiveness analysis. He has been a Visiting Lecturer at the National University of Singapore and is currently an adjunct faculty member at Boston University and an affiliated faculty member at Brown University.

Denise Bury-Maynard

Denise P. Bury-Maynard, MPH, PhD., received her doctorate in Social Policy from Brandeis University in 1999. Her dissertation was entitled “Developing a Utility Index for Substance Abuse: Theory and Application.” She previously completed her Master's in Public Health degree with a concentration in Health Services from Boston University School of Public Health in 1991. She received her undergraduate education at the University of Massachusetts at Amherst where she earned her B.S. in Public Health with a concentration in Epidemiology. Dr. Bury-Maynard assumed her current position, Outcomes Research Scientist the Pfizer Outcomes Research Group in Groton, CT, in 2001. Previously, she was a NIAAA post-doctoral fellow at the Center for Alcohol and Addiction Studies at Brown University working with Drs. Robert Swift, Robert Stout and Richard Longabaugh. Prior to that time she worked as a research assistant and project manager while a full time graduate student and NIAAA pre-doctoral at Brandeis University's Schneider Institute for Health Policy, working with Prof. Donald Shepard. She has held positions as an Epidemiologist for the State of Rhode Island Department of Health, as a Biomedical Data Specialist at the Harvard School of Public Health/DFCI/FSTRF ECOG clinical trials group and as a CRA with Bard Vascular Systems. In addition she worked for Dr. John Ware at QualityMetric in Lincoln RI as well as in the Government Programs (Medicare/Medicaid) Marketing Division of an HMO. Her current research interests include: 1.Costs and consequences of Alcohol Abuse and Dependence (AAD) (and measurement of consequences related to AAD), 2. Costs and consequences of obesity, in particular comorbidities related to obesity. Her latest presentation, entitled “The Medical Costs of Diabetes Mellitus, Coronary Heart Disease, Hypercholesterolemia, Essential Hypertension, Sleep Apnea and Major Depression Attributable to Obesity,” was a presented poster at the North American Association for Society on Obesity (NAASO) in Nov. 2004.