Public Policy, Attitudes and Willingness to Pay for Treatment of Substance Dependence in Iran Publisher Pubmed



Ahmadian Moghaddam S¹ ; Mazyaki A² ; Razaghi EM³ Show Affiliations
Source: International Journal of Drug Policy Published:2019

Abstract

Background: Evaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach. Aim: To assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment. Method: Willingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers’ attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment. Results: In methadone maintenance clinics the payers’ income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p<0.001 ). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p<0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p<0.01 ) and consumption experience (45%, p<0.01 ) showed an inverse association with WTP in regression equation. Conclusion: This study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers’ views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy. © 2019 Elsevier B.V.