Society Lecture 2009: Addiction Treatment: Do economists contribute to the policy debate?

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Professor Christine Godfrey

Professor of Health Economics

Christine Godfrey is the Head of the Department of Health Sciences and a Professor of Health Economics at the University of York.  She leads the Addiction Research Team which consists of psychologists, statisticians, trial specialists and information scientists as well as other health economists researching into alcohol, tobacco and illicit drug interventions and policies.  She is a past president of the Society for the Study of Addiction, and is currently a member of the WHO Expert Committee on Drug Dependence.  She has a number of national policy links including previously acting as an economic advisor to the Home Office, being a member of the Scientific Committee of Tobacco and Health at the Department of Health and is currently acting as an advisor to the House of Commons Health Select Committee for their inquiry on alcohol.  Current research projects includes three linked randomised controlled trials (RCTs) of the effectiveness and cost-effectiveness of implementing screening and brief interventions for hazardous alcohol consumption in primary care, accident and emergency departments and criminal justice settings as part of a Department of Health funded SIPS project,  a randomised controlled trial funded by the NIHR HTA programme on stepped care for older hazardous alcohol users and a further RCT on the effectiveness and cost effectiveness of two internet interventions to reduce hazardous alcohol use.  She is the academic lead of the Physical Health and Addiction research theme of the newly established NHS Leeds, York and Bradford CLAHRC and a member of the AMPHORA project, a large group of European researchers building up the evidence base for alcohol policies across Europe.  Research into smoking includes building epidemiological and economic models which can be used with on-going trials to estimate the relative cost-effectiveness of tobacco control measures compared to other NHS and public health interventions.



There are many different branches of economics which can be applied to the study of addiction.  In this lecture I am exploring the application of economic evaluation techniques to inform research and policy debates about treatment policy for tobacco, alcohol and illicit drug use.  Initial applications of economics led to estimates of the social burden of different substances in monetary terms.  Such figures were used in advocacy for public funding or insurance coverage for treatment.  The argument was to suggest that treatment was one policy strategy for reducing these social burdens.  Further research focussed on attempting to provide more direct evidence that additional treatment would be socially beneficial.   More recently there have been more detailed and technical economic evaluation studies attempting to answer questions about which specific treatments should or should not be supported.  Economists would suggest their methodological research and empirical analyses are designed not to dictate policy choices but to “aid” or be a specific part of the policy debate.  But some of these economic analyses, especially when linked to regulatory agencies such as the National Institute for Health and Clinical Excellence (NICE) in England can have a profound effect on treatment choices for users and service providers.  What are the methodological and ethical challenges of undertaking economic evaluations relevant to addiction treatment policy?  I will argue in this lecture that economists can and should contribute to the addiction treatment policy debate.  However, economists and others are far from agreement on the best assumptions and methodologies to adopt.  The aim of the lecture is to set out some of the major issues illustrated with empirical examples.  An objective is to convince the wider addiction community to become more actively involved in critically understanding and contributing to future studies.  I hope I can convince the audience that economics is not just about “making money talk” but also about setting out the ethical values of policy choices.


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