Cost-effectiveness of inpatient versus outpatient treatment for substance use disorder in Ethiopia: A societal perspective using a Markov model

Cost-effectiveness of inpatient versus outpatient treatment for substance use disorder in Ethiopia: A societal perspective using a Markov model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-effectiveness of inpatient versus outpatient treatment for substance use disorder in Ethiopia: A societal perspective using a Markov model Addisu Tsehay Belete, Adane Melka Wussobo, Anagaw Derseh Mebratie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8386326/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Substance use disorders are a growing burden in Ethiopia, contributing to 34% of the non-communicable disease (NCD) burden and accounting for 86% of indirect costs. Current treatment is largely facility based, with two main modalities: inpatient (ITC) and outpatient (OTC). However, the relative cost-effectiveness of these two approaches remains unclear. This study aims to evaluate the cost-effectiveness of ITC versus OTC treatment for SUD in Ethiopia. Methods: A cohort-based Markov model was used to compare the cost-effectiveness of inpatient versus outpatient treatment for SUDs. Costs were assessed from societal perspective, and reported in United States Dollar (US$), 2022. Effectiveness was measured in terms of disability adjusted life year (DALY) averted. Model input parameters were obtained from the literature review and local data. Both the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER) were calculated. One-way and probabilistic sensitivity analysis was performed to assess the robustness of the findings. The analysis was conducted using Microsoft Excel, with visual basic application (VBA) macros for sensitivity analysis. Results: The baseline cost of ITC was US$33,626 (range: US$26901-40351), while the baseline cost of OTC was US$27,036 (range: US$21629-32444) per patient treated, with comparable effectivenessin terms of DALY averted. The ACER of ITC was US$102, while that of OTC was US$82 per DALY averted. The ICER of ITC compared to OTC was US$3,710 per DALY averted and it exceeds the WHO-CHOICE cost-effectiveness threshold of one to three times Ethiopia’s GDP per capita (US$1027.59). The ICER results were sensitive to changes in treatment cost and effectiveness. Conclusions: The SUD treatment in Ethiopia is associated with a significant financial burden. While OTC is more cost-effective than ITC, it remains largely inaccessible and unaffordable. Integrating SUD services into primary health care could enhance access and reduce costs, with specialized OTC and ITC care reserved for severe cases. Moreover, the management of SUD should be included in the benefit packages of community-based health insurance (CBHI) scheme, to provide financial protection against health expenditures, particularly for the poor. Cost-effectiveness Inpatient treatment Outpatient treatment Substance use disorder Ethiopia Societal perspective Markov model Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers invited by journal 13 Jan, 2026 Editor invited by journal 22 Dec, 2025 Editor assigned by journal 20 Dec, 2025 Submission checks completed at journal 20 Dec, 2025 First submitted to journal 17 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8386326","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":574186629,"identity":"0f4f2c52-5169-4994-99b6-1895c421a02a","order_by":0,"name":"Addisu Tsehay 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Current treatment is largely facility based, with two main modalities: inpatient (ITC) and outpatient (OTC). However, the relative cost-effectiveness of these two approaches remains unclear. This study aims to evaluate the cost-effectiveness of ITC versus OTC treatment for SUD in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cohort-based Markov model was used to compare the cost-effectiveness of inpatient versus outpatient treatment for SUDs. Costs were assessed from societal perspective, and reported in United States Dollar (US$), 2022. Effectiveness was measured in terms of disability adjusted life year (DALY) averted. Model input parameters were obtained from the literature review and local data. Both the average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER) were calculated. One-way and probabilistic sensitivity analysis was performed to assess the robustness of the findings. The analysis was conducted using Microsoft Excel, with visual basic application (VBA) macros for sensitivity analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The baseline cost of ITC was US$33,626 (range: US$26901-40351), while the baseline cost of OTC was US$27,036 (range: US$21629-32444) per patient treated, with comparable effectivenessin terms of DALY averted. The ACER of ITC was US$102, while that of OTC was US$82 per DALY averted. The ICER of ITC compared to OTC was US$3,710 per DALY averted and it exceeds the WHO-CHOICE cost-effectiveness threshold of one to three times Ethiopia’s GDP per capita (US$1027.59). The ICER results were sensitive to changes in treatment cost and effectiveness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eThe SUD treatment in Ethiopia is associated with a significant financial burden. While OTC is more cost-effective than ITC, it remains largely inaccessible and unaffordable. Integrating SUD services into primary health care could enhance access and reduce costs, with specialized OTC and ITC care reserved for severe cases. Moreover, the management of SUD should be included in the benefit packages of community-based health insurance (CBHI) scheme, to provide financial protection against health expenditures, particularly for the poor.\u003c/p\u003e","manuscriptTitle":"Cost-effectiveness of inpatient versus outpatient treatment for substance use disorder in Ethiopia: A societal perspective using a Markov model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 16:54:54","doi":"10.21203/rs.3.rs-8386326/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-03T15:58:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243146325203067143458063846067436115765","date":"2026-01-21T18:38:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-13T10:47:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-22T11:20:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-20T05:25:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-20T05:24:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-12-17T13:22:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d3ee3df-6fa6-4719-8992-d314d9e31fe2","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-14T16:54:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-14 16:54:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8386326","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8386326","identity":"rs-8386326","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}