RTI International is a trade name of Research Triangle Institute

1. The Effect of Alternative Staff Time Data Collection Methods on Methadone Treatment Service Costs Presented byGary A. Zarkin, Laura J. Dunlap, Alexander J. Cowell, Brendan Wedehase, and Ling Lewat theAddiction Health Services ConferenceOctober 24-26, 2005, Santa Monica, CAThis study was funded under NIDA grant No. R01-DA15655. 3040 Cornwallis Road ■ P.O. Box 12194 ■ Research Triangle Park, NC 27709 Phone 919-452-3161 Fax 919-541-6683 e-mail bwedehase@rti.org RTI International is a trade name of Research Triangle Institute

2. Costing Methods • Multiple methods of costing treatment • Total cost per program • Annual cost per patient (slot) • Cost of treatment episode • Cost of specific treatment services (service-level costing) • Substance Abuse Services Cost Analysis Program (SASCAP) • Zarkin, Dunlap, and Homsi. 2004. Evaluation and Program Planning.

3. Service-Level Costing • Advantages • Estimate cost per unit for specific services • Total cost per specific patient • Cost for service bundles • Estimate cost-effectiveness of specific services • Can help inform providers and policymakers about reimbursement rates about specific services • Disadvantage • Data collection more costly and more burdensome • As disaggregate costs, may introduce measurement error

4. SASCAP Methodology • Questionnaire designed to be answered by a key informant knowledgeable about program’s costs and staff’s time allocation. • Consists of 2 parts— • Cost module collects detailed data on program’s annual costs (labor, contracted services, depreciation, building, supplies and materials). • Labor module asks a key informant to allocate all staff time across 8 treatment services and 5 program activities.

5. Data Collection Approaches for Staff Time • Key Informant (current SASCAP method) • Data provided by program director • Completed once by director for all staff • Lowest burden on program staff and researchers • Staff survey • Ask staff to allocate own hours across services for a “typical” week • Completed once by each staff person • Diary • Staff maintain one-week diary to record actual time across services • Completed daily by each staff over the one-week period • Highest burden on program staff and researchers

6. Research Question • Do service cost estimates and the cost of collecting data required for these estimates vary across alternative data collection methodologies?

7. Data Collection • Collecting data from 20-25 methadone treatment programs. • Key informant survey (SASCAP) sent out 4 weeks prior to site visit. • One-day Site Visit: • Meet with key informant to review completed SASCAP • Administer Staff Time Allocation Survey during group staff session • Train staff on how to complete diaries • Staff Diaries begin next day and kept for one-week. • Completed questionnaires reviewed by RTI and follow-up calls made as necessary to clarify information provided.

8. Patient Services Initial Patient Assessment Initial Medical Services Ongoing Medical Services Methadone Dosing Individual Counseling Group Counseling Patient Educational Services Case Management/Support Program Activities Quality Assurance Program Evaluation Staff Education Administrative activities Patient-specific General program Program Services and Activities

9. Staff Time Allocation Survey Patient Services

10. Treatment Program Locations

11. Selected Programs Characteristics

12. Average Weekly Hours per Staff for Specific Services*

13. Average Minutes per Session

14. Cost per Session (2004$)

15. Lessons Learned…so far • Key Informant: Lowers program’s burden and makes reconciling data issues at follow-up much easier. • Program Size: Key informants at larger programs have harder time filling out staff time allocation, but burden of collecting staff data increases. • Typical Week: With diary, data collection may not reflect typical week at work. • Discrete Services: Most staff do not think of their time in discrete services/activities.

16. Discussion • Service-cost estimation provides meaningful results and has “convergent validity”—increases confidence in service cost results. • Service costs are approximately the same for all 3 methods. • Given the lower burden of key informant method, our preliminary results suggest that this method may be preferred for most uses. • However, for programs where the key informant is not well-informed about staffing (e.g., large programs, higher proportion of part-time/weekend staff), the time allocation survey may dominate.