Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada

BMC Public Health, Jun 2013

Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) constitute a special population that may be at particularly high risk for substance use. The purpose of the current study was to estimate the utilization of specialized addiction treatment services (SATS) and the associated cost, as a part of the total cost of health care associated with FASD in Canada. Methods The current study was a modeling study. Data on SATS by lifetime mental disorder status were obtained from the Drug and Alcohol Treatment Information System (DATIS) in Ontario, Canada for 2010/11. The number of clients with FASD who received SATS in Ontario in 2010/11 was estimated, assuming that approximately 37% (confidence interval: 21.6%-54.5%) of individuals with FASD abuse or are addicted to alcohol and/or drugs and that their utilization rate of SATS is the same as those for people with a lifetime mental disorder. The data from DATIS was then extrapolated to the total Canadian population. Results The cost of SATS for clients with FASD in Canada in 2010/11 ranged from $1.65 million Canadian dollars (CND) to $3.59 million CND, based on 5,526 outpatient visits and 9,529 resident days. When the sensitivity analysis was performed the cost of SATS ranged from $979 thousand CND to $5.34 million CND. Conclusions Special attention must be paid to at-risk groups of individuals such as those with FASD, in order to reduce the likelihood of the development of co-morbid substance abuse problems, and thus, reducing the overall burden on Canadian society.

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Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada

BMC Public Health Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada Svetlana Popova 0 1 Shannon Lange 0 1 Larry Burd Karen Urbanoski 0 1 Jrgen Rehm 0 1 0 Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON M5T 3M7 , Canada 1 Social and Epidemiological Research Department, Centre for Addiction and Mental Health , 33 Russell St., Toronto, ON M5S 2S1 , Canada Background: Individuals with Fetal Alcohol Spectrum Disorder (FASD) constitute a special population that may be at particularly high risk for substance use. The purpose of the current study was to estimate the utilization of specialized addiction treatment services (SATS) and the associated cost, as a part of the total cost of health care associated with FASD in Canada. Methods: The current study was a modeling study. Data on SATS by lifetime mental disorder status were obtained from the Drug and Alcohol Treatment Information System (DATIS) in Ontario, Canada for 2010/11. The number of clients with FASD who received SATS in Ontario in 2010/11 was estimated, assuming that approximately 37% (confidence interval: 21.6%-54.5%) of individuals with FASD abuse or are addicted to alcohol and/or drugs and that their utilization rate of SATS is the same as those for people with a lifetime mental disorder. The data from DATIS was then extrapolated to the total Canadian population. Results: The cost of SATS for clients with FASD in Canada in 2010/11 ranged from $1.65 million Canadian dollars (CND) to $3.59 million CND, based on 5,526 outpatient visits and 9,529 resident days. When the sensitivity analysis was performed the cost of SATS ranged from $979 thousand CND to $5.34 million CND. Conclusions: Special attention must be paid to at-risk groups of individuals such as those with FASD, in order to reduce the likelihood of the development of co-morbid substance abuse problems, and thus, reducing the overall burden on Canadian society. Fetal alcohol syndrome; Fetal alcohol spectrum disorder; Addiction; Specialized treatment; Utilization; Cost; Canada - Background This study is a part of a large economic study on the estimation of the burden and cost associated with Fetal Alcohol Spectrum Disorder (FASD) in Canada [1,2]. FASD is a non-diagnostic term that encompasses four alcohol-related clinical diagnoses, including: Fetal Alcohol Syndrome (FAS), Partial FAS, Alcohol-Related Neurodevelopmental Disorder, and Alcohol-Related Birth Defects. Individuals with FASD have an increased vulnerability to certain risk factors, which put them at a higher risk for substance use/abuse problems, as a result of the damage caused to their central nervous system due to their exposure to alcohol prenatally. This damage manifests as developmental delays, cognitive impairments, mental disorders, high rates of incarceration and an increased rate of substance abuse [3-5]. The impairments expressed by individuals with FASD typically lead to high-risk behaviours, such as alcohol/ drug abuse or an increased likelihood of being in highrisk situations (increasing the chance of being exposed to alcohol and/or drugs). Currently, there are not many epidemiological studies reporting on the prevalence of substance use/abuse among individuals with FASD. However, the literature does indicate that a disproportionate number of individuals with FASD will have problematic substance use issues at some point in their lives [6]. For instance, Famy et al. [7] reported a prevalence of 55% for alcohol/drug dependence among their sample of individuals with FAS. Additionally, Clark and colleagues [8] and Streissguth and colleagues [9] reported that 22% and 35% of their respective cohorts of individuals with FASD had problems with alcohol/drugs. Lastly, in a study conducted by Grant and colleagues [10], about 68% of women with FASD had reported abusing alcohol and 79% had used illegal drugs in the 10 months prior to being admitted into a community program. There are a few potential explanations for the high prevalence of substance use among individuals with FASD: 1) a biological vulnerability to substance use may exist; 2) individuals with FASD may use substances to self-medicate; and 3) individuals with FASD tend to have difficulties with impulse control, making them susceptible to developing a substance use disorder [11]. Regardless of the reason for such high rates of cooccurring substance use problems and FASD, this population places a greater demand on treatment service providers, given that they suffer from multiple comorbid mental disorders [8,12,13]. Prenatal alcohol use exposes three generations to the harmful effects of alcohol (the mother, the fetus, and the germ line of the fetus). Increased rates of substance abuse increase the risk for additional familial cases of FASD (multiple affected siblings), and increase the risk of generational FASD [3,14]. Therefore, it is also important to address the issue of women (...truncated)


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Svetlana Popova, Shannon Lange, Larry Burd, Karen Urbanoski, Jürgen Rehm. Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada, BMC Public Health, 2013, pp. 570, 13, DOI: 10.1186/1471-2458-13-570