Cost-Effectiveness Analysis of Inpatient Versus Outpatient Treatment Centers for Substance Use Disorder in Ethiopia: A Markov model from a Societal Perspective
| dc.contributor.advisor | Adane Melka | |
| dc.contributor.advisor | Anagew Derseh | |
| dc.contributor.author | Addisu Tsehay | |
| dc.date.accessioned | 2026-03-06T06:05:05Z | |
| dc.date.available | 2026-03-06T06:05:05Z | |
| dc.date.issued | 2025-06-01 | |
| dc.description.abstract | Background: Substance use disorders are a growing burden in Ethiopia, accounting for 34% of NCDs burden and higher indirect costs (86%). The treatment of SUD in Ethiopia, which is traditionally facility based, Inpatient (ITC) and outpatient (OTC) interventions are the two treatment modalities, yet their cost-effectiveness remains uncertain. This study aims to evaluate the cost-effectiveness of Inpatient (ITC) versus Outpatient (OTC) treatment for SUD in Ethiopia. Methods: A retrospective cohort study design was used for conducting a full economic evaluation using a Markov model to assess the cost-effectiveness of SUDs treatment at inpatient (ITC) and outpatient (OTC) treatment centers in Addis Ababa, Ethiopia. A total of 282 SUD patients aged 18 and above was selected by simple random sampling. A bottom-up ingredient micro costing approach was employed to collect a relevant cost data. The primary cost and effectiveness data were collected from inpatient (ITC), outpatient (OTC) treatment centers and patient interviews to inform the Markov Model. Costs were evaluated from a societal perspective, and effectiveness was measured in terms of DALY averted, with both costs and effects discounted at 3%. The model, developed in Microsoft Excel, included six health states with start age of 18, and a one-year cycle length with a lifetime horizon. Data entry and analysis was also undertaken using Microsoft Excel. Caregiver costs were excluded due to data reliability concerns. Results: The estimated life time costs of SUD treatment was USD 33,626 for ITC and USD 27,036 for OTC. The Average Cost Effectiveness Ratio (ACER) indicates that USD 102 per DALY averted is required for ITC, while only USD 82 per DALY averted is needed for OTC. In this regard, OTC is deemed the preferred option. The analysis further revealed that SUD treatment at ITC is not a cost-effective, with an ICER of USD 3710 per DALY averted, exceeding Ethiopia’s cost-effectiveness threshold of one to three times the GDP per capita. In contrast, the study identified SUD treatment at OTC as a cost-effective alternative. Conclusion: The SUD treatment in Ethiopia is associated with a significant financial burden. While outpatient care (OTC) is more cost-effective than inpatient (ITC), it remains largely inaccessible and unaffordable. Integrating SUD services into primary health care could enhance access and reduce costs, with specialized care reserved for severe and complex cases. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/7859 | |
| dc.language.iso | en | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Cost-effectiveness | |
| dc.subject | Inpatient Treatment | |
| dc.subject | Outpatient Treatment | |
| dc.subject | Substance use Disorder | |
| dc.subject | Ethiopia | |
| dc.subject | Markov Model | |
| dc.title | Cost-Effectiveness Analysis of Inpatient Versus Outpatient Treatment Centers for Substance Use Disorder in Ethiopia: A Markov model from a Societal Perspective | |
| dc.type | Thesis |