Drug and alcohol treatment: how much does it cost in Europe?

In 2016, more than 1.5 million people across the European Union (28), Turkey and Norway received medical treatment for illicit drug use. In a quarter of these countries, more than 30% of patients were treated in hospital, although the role of hospitals in providing treatment varies markedly across countries. How much is spent on treating these patients is not known. Despite the fact that, among other ends, knowing how much is spent supports cost-effectiveness and policy analysis. Expenditure estimates allow a better allocation of scarce resources, serving service providers, health policy makers and tax payers. However, expenditure data have been frequently unavailable.

This study aims, first, to develop a method to estimate expenditure on hospital treatment of illicit drug and alcohol use, in Europe; second, to estimate and compare these spending; third, to investigate the factors that explain recent expenditure trends and; last but not least, to discuss their impact on policy and cost-effectiveness.

The study uses Eurostat data, complying with the System of Health Accounts and covering the European Union (28) and Norway. Data are grouped by ‘Mental and Behavioral Disorders’ and, more specifically, by disorders caused by the use of alcohol and by the use of other psychoactive substances.

The study uses ‘attributable fractions’ to estimate expenditure. Fractions disentangle drug and alcohol expenditure out of total hospital expenditure, based on activity data (discharges and total bed days). Additionally, the study applies econometric modeling, such as population-average models, to combine multi-country data with time series, and to explain expenditure determinants, countries differences and time trends.

This study estimates that, in 2015, EUR 5.9 thousand million were spent to treat alcohol diagnoses in hospitals, while EUR 3.3 thousand millions were spent on drug treatment, in the set of 24 European countries (with data available). In 2015, on average spending on alcohol treatment exceeded by EUR 2.6 thousand spending on drug treatment in these countries. This difference remained stable over the period 2013-2015, varying within the range EUR 2.6 to EUR 2.8 thousand millions. Per capita, on average, EUR 18.6 and EUR 14.4 were spent on alcohol and drug diagnosis, respectively.

Preliminary results suggest that cross-country differences are explained by prevalence rates, hospital prices and the structures of health systems (for instance, the proportion of spending allocated to preventive care).