International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse

Appendix H - Issues relating to the estimation of aggregate and avoidable costs of substance abuse in Central and Southern America

The following observations are drawn from the reported experience of, and the paper presented by, Dr Augusto Pérez-Gómez and his CICAD colleagues, together with discussions at the 2005 Heath Canada Ottawa workshop. These observations reflect some of the issues relevant to the undertaking by developing countries of studies of the aggregate avoidable costs resulting from substance abuse.

There are a number of constraints in undertaking such studies which need to inform the study design, analysis and interpretation of results.

Data

Where there are no official statistics and no reliable data, it may be necessary to use proxy data to model from a comparator country. Ideally, this country should be as similar as possible to the study country. When the proxy data are epidemiological, information from the UN and WHO, and from other countries may all combine to provide a basis for comparison.

The work of Dr Pérez-Gómez refers predominantly to illicit drugs but sometimes also to alcohol, for which there are either very little or no official data, only estimates and a little survey data. Some of this information relates to policing and law enforcement but, as with other crime data collection, there are difficulties in determining the attributable fractions.

Estimates

It is often necessary to rely on estimates and expert opinion, which are the least authoritative level of evidence, and very far from the gold standard. Policy implications from these sources require cautious consideration.

As base-line cost data are currently being collected by CICAD in six countries, it should be possible to undertake avoidable cost estimates in some of those countries. When the initial base-line costs become available, they should be examined to determine whether the avoidable costs methodology could be applied to some of the identified cost categories.

Evaluation of prevention programs

These programs are reportedly usually very small and not very effective. Budgets for such programs are usually not identified, and they appear to be conducted independently of state and national policies. This makes the generalisability of the outcomes of such programs very difficult, in terms of their utility in determining avoidable costs.

Researchers

To undertake avoidable costs studies, it will be of great advantage to use the experience of researchers who have become familiar with the collection and use of cost data in the study countries.

The following tables from the workshop presentation of Dr Pérez-Gómez summarise CICAD's views of the relevance of illicit drugs and alcohol to the aggregate and avoidable social costs of substance abuse in Central and South America.

Table 23 - Relevance of avoidable costs to the health and welfare system in Central and South American countries

	Alcohol			Illicit drugs
	High	Fair	Low	High	Fair	Low
Medical	Costa Rica, Argentina, Uruguay	Mexico	Colombia, Peru, Venezuela	Argentina	Costa Rica, Uruguay	Most
Hospital	El Salvador, Mexico	Costa Rica, Uruguay, Argentina	Most	El Salvador	Mexico, Uruguay, Costa Rica	Most
Nursing homes	n.a.	n.a.	n.a.	n.a.	n.a.	n.a.
Pharmaceuticals			All		Argentina, Brazil	Most
Ambulances			All			All
Research			All		Costa Rica, Peru, Brazil, Mexico	Most
Prevention			All			All
Social reinsertion			All		Peru, Colombia, Mexico, Costa Rica	Central American countries, Caribbean countries
Welfare administration			All			All
Treatment		Most	Ecuador, Panama, Caribbean countries	El Salvador	Most	Ecuador, Panama, Caribbean countries

Note: n.a. denotes not available

Table 24 - Attributed relevance of alcohol and drugs to the commission of specific crimes/offences in Central and South American countries

Table 25 - Relevance of illicit drugs to the judiciary system in Central and South American countries

	High	Fair	Low
Law enforcement	Colombia, Peru, Mexico, Venezuela	Bolivia, Ecuador, Panama, Brazil	Belize, Guyanas
Criminal courts	Colombia, Peru, Brazil	Caribbean countries, Central American countries, Venezuela	Belize, Guyanas
Prisons	Colombia, Peru, Central American countries	Argentina, Chile, Caribbean countries	Uruguay, Panama, Bolivia
Customs	Colombia, Peru, Brazil, Ecuador, Mexico	Panama, Haiti, Dominican Republic, Venezuela, Central American countries, Caribbean countries	Argentina, Panama, Bolivia
Organised crime	Colombia, Peru, Brazil, Mexico, El Salvador	Central American countries, Jamaica	Argentina, Caribbean countries, Chile, Bolivia
Forgone product			All
Property theft		Argentina, Chile, Brazil	Most
Violence	Colombia, Peru, Caribbean countries, Brazil	Jamaica, Venezuela	Argentina, Uruguay, Ecuador, Bolivia
Money laundering	Colombia, Peru, Caribbean countries	Brazil, Venezuela	Argentina, Colombia, Uruguay, Ecuador