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Senate orders for production of documents—Health—Alcohol and drug treatment and rehabilitation services—Order agreed to on 7 September 2017—Drug and Alcohol Service Planning Model—Final report to the Intergovernmental Committee on Drugs (IGCD) on the development of a population based planning tool for Australia, dated 16 August 2013


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A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model

Drug and Alcohol Service Planning Model

FINAL REPORT

to the

Intergovernmental Committee on Drugs (IGCD) on the development of a population based planning tool for Australia

16 August 2013

Attachment A

AHMAC Meeting 20 September 2013 - Agenda Item 5.3 Attachment A (issued 5 September 2013)

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 2

Copyright

This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health.

The State Government of NSW (as represented by NSW Ministry of Health) grants to each State, Territory or Commonwealth Government in Australia a perpetual, irrevocable, royalty-free and licence fee-free, world-wide, non-exclusive licence (including a right of sub-licence) to use, copy, modify and exploit the materials associated with this work.

© NSW Ministry of Health 2013

For further information please contact:

Mr David McGrath

Director

Mental Health and Drug and Alcohol Programs

NSW Ministry of Health

LMB 961

NORTH SYDNEY NSW 2059

Phone: (02) 9391 9278

Email: david.mcgrath@doh.health.nsw.gov.au

Report Prepared/Compiled by

Team: Strategic Planning & Evaluation Team

Mental Health and Drug and Alcohol Office

NSW Ministry of Health

Date: 16 August 2013

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 3

Table of Contents FOREWORD 5

ACKNOWLEDGMENTS 6

1 EXECUTIVE SUMMARY 8

2 INTRODUCTION 10

3 PURPOSE, OBJECTIVES AND EXPECTED BENEFITS 12

3.1 Purpose 12

3.2 Objectives 12

3.3 Expected Benefits 12

4 PROJECT GOVERNANCE 13

4.1 Steering Committee 13

4.2 Expert Reference Group 13

4.3 NSW Ministry of Health Project team 13

5 PROJECT DELIVERABLES 15

6 DEVELOPMENT OF PRELIMINARY INDIGENOUS ADAPTATION TO THE DRUG AND ALCOHOL SERVICE PLANNING MODEL FOR AUSTRALIA 16

7 FINANCIAL MANAGEMENT 17

8 MODEL SCHEMA 18

9 PROJECT METHOD 20

9.1 The Epidemiology 20

9.2 Drug types 20

9.3 Age groups 21

9.4 Treatment need and treatment demand 21

9.5 Care packages 26

9.6 Allocating patients to care packages 27

9.7 Complex patients and care packages 27

9.8 Items that are not 12 month care packages: the standalone item 28

9.9 Items that are not 12 month care packages: Prevention 28

9.10 Items that are not 12 month care packages: Harm reduction 28

9.11 Items that are not 12 month care packages: screening and brief intervention 29

9.12 Relapse and readmission 29

9.13 Resource estimation: the cost of clinical staff FTE 30

9.14 Resource estimation: diagnostic tests and prescribed medications 30

10 IN SCOPE AND OUT OF SCOPE ITEMS 31

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 4

10.1 In Scope 31

10.2 Out of Scope 32

11 RESULTS 33

12 DISCUSSION 40

13 CONCLUSION 44

14 REFERENCES 45

15 TABLES & FIGURES 47

15.1 List of Tables 47

15.2 List of Figures 48

16 APPENDIX 1 - ESTIMATOR TOOL STANDARD REPORTS 49

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 5

Foreword This report serves as the final report of the Drug and Alcohol Service Planning Model for Australia: final report to the Intergovernmental Committee on Drugs (IGCD) on the development of a population based planning tool for Australia

It has been prepared for the purposes set out in the Agreement between the Commonwealth (Department of Health and Ageing) and the State of New South Wales (NSW South Wales Health) dated 27 July 2010 (“Agreement”).

Pursuant to the Agreement, the Final Report must include:

• a Financial Statement endorsed by a financial officer of the State; • a comprehensive report on whether the objectives and outcomes of the Project were achieved and if not, the reasons why those objectives and outcomes were not achieved; and

• a copy of the dissemination strategies developed as part of the Project.

This report should also be read in conjunction with:

• The Drug and Alcohol Service Planning Model for Australia-Technical Manual • The Drug and Alcohol Service Planning Model for Australia-Estimator Tool • The Drug and Alcohol Service Planning Model for Australia-Estimator Tool User Guide,

The estimates included in this report are derived from:

• The Drug and Alcohol Service Planning Model for Australia-Estimator Tool (Version 2.4.1)

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 6

Acknowledgments The Drug and Alcohol Service Planning Model for Australia was funded by the National Drug Strategy and Commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model.

The Project was funded for a two year period from 1 April 2010 to 31 March 2012. The NSW Ministry of Health1

was the lead agency for the Project. An unfunded extension was granted from 1 April 2012 to December 2012.

The NSW Health Project Team, Mental Health and Drug and Alcohol Office (MHDAO), NSW Ministry of Health, gratefully acknowledge the invaluable assistance, support and input provided the Project’s Steering Committee and Expert Reference Group members, all of whom have contributed to the success of the project.

Two smaller grants were also approved by the Intergovernmental Committee on Drugs (IGCD). The first grant funded representatives of the National Indigenous Drug and Alcohol Committee (NIDAC) to develop Indigenous specific care packages. The second grant funded information sessions across the jurisdictions.

In particular, the following individuals and organisations are thanked for their respective roles in the development and implementation of this project.

Project Steering Committee Members:

• Mr David McGrath (MHDAO, NSW Ministry of Health, co chair) • Ms Colleen Krestenson (DoHA, co chair) • Mr Simon Cotterell (former member DoHA, co chair) • Ms Judith Abbott (Department of Health, VIC) • Ms Gayle Anderson (former member, OATSIH) • Mr Steve Anstis (former member, QLD Health) • Mr Pier DeCarlo (former member, Department of Health, VIC) • Ms Helene Delany (Alcohol & Other Drugs Policy Unit, ACT) • Mr Eric Dillon, (former member, Drug & Alcohol Office, WA) • Ms Sylvia Engels (Department of Human Health & Services, TAS) • Ms Sarah Gobbert (Tobacco, Alcohol & Other Drugs, Department of Health, NT) • Mr Neil Guard (Drug & Alcohol Office, Department of Health, WA) • Mr John Shevlin (DOHA) • Mr Anthony Sievers (former member, Department of Health, NT) • Mr John Walker (former member, OATSIH) • Mr Tony Woollacott (SA Health)

1 As at 6 October 2011, the NSW Department of Health was renamed the NSW Ministry of Health

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Expert Reference Group Members:

• Prof Alison Ritter (National Drug and Alcohol Research Centre, UNSW, chair) • Ms Susan Alarcon (Next Step Drug & Alcohol Service, WA) • Prof Robert Ali (Drug & Alcohol Services SA) • Prof Robert Batey (former member, MHDAO, NSW Ministry of Health) • Ms Myra Brown (former member, WA) Ms Meredythe Crane (ADCA) • Dr Robyn Davies (Drug Strategies Branch, DoHA) • Ms Liz Davis (former member, Mental Health, Alcohol & Other Drugs Directorate,

QLD)

• Ms Helene Delany (Alcohol & Other Drugs Policy Unit, ACT) • Ms Sarah Gobbert (Tobacco, Alcohol & Other Drugs, Department of Health, NT) • Prof Dennis Gray (National Drug Research Institute, Curtin University, WA) • Mr James Hunter (Drug & Alcohol Office, WA) • Ms Debbie Kaplan (MHDAO, NSW Ministry of Health) • Assoc Prof Nick Lintzeris (Fellow of Australasian Chapter of Addiction Medicine) • Prof Dan Lubman (Turning Point Alcohol and Drug Centre, VIC) • Ms Ashleigh Lynch (former member, OATSIH, DoHA) • Associate Professor Lynne Magor-Blatch (Australasian Therapeutic Communities

Association (ATCA) • Ms Tania Murray (former member, QLD) • Ms Elise Newton (former member, OATSIH, DoHA) • Mr Garth Popple (ANCD) • Ms Anita Reimann (Alcohol & Drug Services, TAS) • Mr Anthony Sievers (former member, Department of Health, NT) • Mr Gavin Stewart

NSW Project Team (MHDAO)

• Ms Judith Burgess (MHDAO, NSW Ministry of Health) • Mr Alexander Canduci (MHDAO, NSW Ministry of Health) • Ms Sue Hailstone (MHDAO, NSW Ministry of Health) • Ms Anna Kollias (MHDAO, NSW Ministry of Health) • Dr Harry Perlich (MHDAO, NSW Ministry of Health • Mr Ravneet Ram (MHDAO, NSW Ministry of Health) • Ms Meredith Sims (MHDAO, NSW Ministry of Health) • Ms Linda Smith (MHDAO, NSW Ministry of Health) • Mr Gavin Stewart (MHDAO, NSW Ministry of Health) • Mr Brian Woods (MHDAO, NSW Ministry of Health)

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1 Executive Summary The purpose of the project was to develop a population-based model for drug and alcohol service planning for Australia.

The Project’s objective was to estimate the resources needed in population-based model for drug and alcohol service for Australia (e.g. FTE staff per 100 000 population, and beds per 100 000 population).

The Drug and Alcohol Service Planning Model for Australia thus provides transparency and consistency across all jurisdictions for estimating the need for drug and alcohol services, across the spectrum from early intervention to the most intensive treatment, and across the lifespan. The model also provides the same basis for all jurisdictions to estimate the gap between current need being met, and the resources required to fill that gap.

The Drug and Alcohol Service Planning Model for Australia is a ground breaking step forward for evidence based planning of drug and alcohol services in Australia. It represents a consensus across jurisdictions on a paradigm for planning drug and alcohol services. The Drug and Alcohol Service Planning Model is a static one year model. The model itself provides a structured evidence based approach to drug and alcohol services planning. Jurisdictions also have an opportunity to compare and evaluate their set of drug and alcohol services with the model. It is anticipated that enhanced planning will lead to more effective and efficient services.

Within the Drug and Alcohol Service Planning Model, the five drug types: Alcohol, Amphetamine, Benzodiazepines, Cannabis and Illicit Opioids are modelled for age groups 12-17 years, 18-64 years and 65 years and older. Individual drug types are not modelled for the age groups 0-11 months and 1-11 years, instead, these are modelled as “All Drugs”. A series of care packages were specified by drug type and age group. The care packages specify the type and quantity of care that an individual should receive over 12 months.

Some of the high level outputs of the model include:

• The total estimated expenditure is $2,177,217,219. This is made up of $2,092,820,000 which includes clinical staff FTEs, bed overheads, diagnostic testing and prescription medication. Harm reduction is estimated at $84,397,219 which represents 3.9 percent of the total cost of the model. • A total of 613,939 people treated aged 12 years and older in the 12 month packages. • A total of 2,717,132 people screened aged 12 years and older regarding alcohol,

amphetamines and cannabis use. • A total of 13,081 clinical staff FTEs are estimated to treat people in the mild, moderate and severe groups, all children and the stand alone items. A further 580 clinical staff

FTE are estimated to deliver screening and brief intervention. • A total of 6,723 beds to deliver care to the people treated in the 12 month packages.

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The model does not specify who funds the services. The model’s purpose is to estimate an envelope of resources required to meet the drug and alcohol service needs of Australia. It does not specify funding source(s).

Prevention has not been modelled, but a recommendation regarding the future modelling of prevention in the Drug and Alcohol Service Planning Model for Australia has been made to the Chair of the IGCD from the Expert Reference Group.

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2 Introduction In 2001 NSW developed a model for estimating mental health service needs (New South Wales Department of Health, 2001). The model is called the Mental Health and Clinical Care and Prevention (MH-CCP) model and has been favourably reviewed in international literature (Pirkis et al, 2007).

Planning models endorsed by governments with service delivery and funding responsibilities are not easily built. The review of 32 mental health system plans from Australia, New Zealand, the UK, the US and Canada found that only four predicted overall resource requirements and only two had an epidemiological basis for the resource levels predicted. One was the MH-CCP Version 1.11 model from NSW Health, which laid its cards on the table in 158 pages of documentation that has been available on the NSW Health website since 2001.

The publicly available NSW Health MH-CCP model was used by many other jurisdictions in Australia as a planning guide. This was, in part, possible because there was an established national mental health (public sector only) data collection and a broad service taxonomy for the public sector. The NSW mental health service planning model incorporated ambulatory care models from the Victorian Department of Human Services and optimal staffing profiles for inpatients from Queensland Health.

Prior to the commencement of the Drug and Alcohol Service Planning Model for Australia, there was no agreed population-based model for drug and alcohol service planning in Australia. The provision of a consistent drug and alcohol service planning model would provide a standardised measure across all jurisdictions for estimating the need for drug and alcohol services, across the spectrum from early intervention to the most intensive treatment. It would also provide a basis for all jurisdictions to consistently estimate of the gap between estimated need and current resources.

The Drug and Alcohol Service Planning Model for Australia was commissioned early in 2010 by the Ministerial Council on Drug Strategy (MCDS) through the Intergovernmental Committee on Drugs (IGCD) as a project under the Cost Shared Funding Model (CSFM).

The Project was funded for a two year period from 1 April 2010 to 31 March 2012. The NSW Ministry of Health was the lead agency for the Project with the Ministry’s Mental Health and Drug and Alcohol Office (MHDAO) Project Team responsible for providing secretariat support to committees, for assembling the model, and for producing a technical report and spreadsheets that perform the population-based calculations. Previous MH-CCP modelling of the need for mental health services in NSW has informed the development of this drug and alcohol planning model.

The Drug and Alcohol Service Planning Model for Australia is a ‘should be’ model that estimates the resources required to provide an adequate level of drug and alcohol services to a target treatment population. In simple terms, the model takes epidemiological data on rates of diagnosed ill for different drugs (by age group) and then estimates the need for resources based on the modelled drug and alcohol services provided to the persons treated

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 11

per 100,000 of age specific population. The rate of resources per 100,000 is then extrapolated to different population sizes, for example ten clinical staff FTE per 100,000 people aged 18 to 64 years. The model’s epidemiology is driven by the total Australia population; accordingly the model can be described as the “all peoples’” model.

The Drug and Alcohol Service Planning Model for Australia estimates resources for five drug types and five age groups. The major drug types are alcohol, amphetamine, benzodiazepine, cannabis and illicit opioids. These five drug types are applied to three age groups: 12-17 years, 18-64 years, and 65 years and older. A generic ‘all drugs’ was applied to the age groups 0-11 months, and 1-11 years.

The scope of this model is limited to “health” departments’ funding of drug and alcohol services. The model is a planning tool and it will assist jurisdictions to guide the distribution of resources, and where appropriate, redistribution of current resources. The model is a static one year model. It is not a resource distribution formula.

The key product from the Project, the Drug and Alcohol Service Planning Estimator Tool (MS Excel format), includes a back end database with a reporting tool front end that provides exhaustive resource demand and cost reporting, with a flexible user-friendly interface. The Estimator Tool also:

• Allows users to model resource needs and costs for every Australian State and Territory, from the present to 2031 • Allows users scope to develop their own reporting outputs, based on the database and flexible pivot tables • Allows users to revise the database, to vary population base to local demographics • Allows users to alter prevalence rate of diagnostics inputs for the drugs, to suit

jurisdictional characteristics • Allows users to alter salary rates in the model, to produce more nuanced cost outputs to suit jurisdictional characteristics.

The Estimator Tool reports the following drug and alcohol resource need estimates (as a quantity and cost):

• Clinical staff FTE by staff category and service setting • Beds by service setting • Diagnostic tests • Prescription medicine.

Extensive detail regarding the modelling is contained in the associated Technical Manual.

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 12

3 Purpose, objectives and expected benefits 3.1 PURPOSE

To develop a population-based model for drug and alcohol service planning for Australia.

3.2 OBJECTIVES

To estimate the resources needed in a population-based model for drug and alcohol service planning for Australia e.g. FTE staff per 100 000 population, and beds per 100 000 population.

3.3 EXPECTED BENEFITS

The Project has provided a population-based model for drug and alcohol service planning for Australia. The Drug and Alcohol Service Planning Model for Australia:

• Provides transparency and consistency across all jurisdictions for estimating the need for drug and alcohol services, across the spectrum from early intervention to the most intensive treatment, and across the lifespan. • Provides the same basis for all jurisdictions to estimate the gap between current need

being met, and the resources required to fill that gap, for example, FTE clinical staff per 100,000 population, treatment places per 100,000 population, drug and alcohol specialist inpatient beds per 100,000 population.

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4 Project Governance 4.1 STEERING COMMITTEE

The Project’s Steering Committee comprised of health officials representing all jurisdictions with varied professional expertise was established at the beginning of the project by the Intergovernmental Committee on Drugs (IGCD).

The role of the Steering Committee was to provide final decisions on all matters related to the model’s development over the Project period. The Steering Committee helped to resolve issues and policy decisions, approved scope changes and provided direction and guidance to the Project where required. The Steering Committee decided on issues that could not be resolved at the Expert Reference Group level.

The Steering Committee’s Terms of Reference are provided in an appendix of the Drug and Alcohol Service Planning Model’s Technical Manual.

4.2 EXPERT REFERENCE GROUP

The Project’s Expert Reference Group was determined by the Steering Committee.

The role of the Expert Reference Group was to provide a consistent source of expert advice on, and review of the model as it developed, over the project period. This expert advice addressed aspects of the modelling at the epidemiological level, clinical level, and service planning level.

Representatives of the Expert Reference Group included one health official from each State and Territory; health officials from the (Commonwealth) Office for Aboriginal and Torres Strait Islander Health (OATSIH) and the Department of Health and Ageing, Drug Strategy Branch; a representative from the Australian Chapter of Addiction Medicine; National Indigenous Drug and Alcohol Committee (NIDAC); Alcohol and Other Drugs Council of Australia (ADCA); Australian National Council on Drugs (ANCD); and Australasian Therapeutic Communities Association (ATCA).

A representative from the University of NSW National Drug and Alcohol Research Centre chaired the Expert Reference Group, not only for their high level of expertise but to ensure that the model could interface appropriately with supply models.

The Expert Reference Group’s Terms of Reference are provided in an appendix of the Drug and Alcohol Service Planning Model’s Technical Manual.

4.3 NSW MINISTRY OF HEALTH PROJECT TEAM

The NSW Ministry of Health was the lead agency for the Project. Staff within the Ministry’s Mental Health and Drug and Alcohol Office (MHDAO) were responsible for conducting

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 14

modelling in accordance with the Expert Reference Group advice on priorities and options to be considered; and for providing feedback between meetings on additional inputs and priorities received from the Steering Committee. The Project Team provided the necessary secretariat services and were also responsible for providing a venue for the face-to-face meetings of the Expert Reference Group.

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5 Project Deliverables In conjunction with this report, the NSW Ministry of Health has provided:

• A tool that performs the calculations and shows the drug and alcohol resources needed per 100,000 population and for the selected population (e.g. Australian, State, Territory or other population). This is an Excel file and is known as the Drug and Alcohol Service Planning Model for Australia - Estimator Tool. • A Drug and Alcohol Service Planning Model for Australia - Estimator Tool User Guide,

which explains how to use the Estimator Tool. • A Drug and Alcohol Service Planning Model for Australia - Technical Manual, which provides detail of the modelling undertaken.

Once approved by the IGCD, the project deliverables will be disseminated by the IGCD secretariat to the jurisdictions.

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6 Development of Preliminary Indigenous adaptation to the Drug and Alcohol Service Planning Model for Australia The IGCD also awarded an additional grant to fund the development of an Indigenous adaption of the Drug and Alcohol Service Planning Model for Australia. Indigenous specific care packages have been developed by the representatives of the National Indigenous Drug and Alcohol Committee (NIDAC) for ages 12 years and older. Given limitations on time and resources , care packages were not developed for children aged 0-11 years, nor was Indigenous specific modelling undertaken regarding harm reduction and prevention. While the NIDAC representatives have completed some of the care packages there remains a considerable body of work to develop an Indigenous adaption of the Drug and Alcohol Service Planning Model for Australia. Additional funding will be needed to complete this work.

NSW Health has provided IGCD with the results of the work progressed in collaboration with the NIDAC on a preliminary Indigenous adaptation of the model for noting. This work includes a copy of theIndigenous care packages developed as well as the related advice provided by NIDAC. This information is expected to inform the Indigenous adaptation of the model to be progressed as a 2013/14 cost shared funding model project.

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7 Financial Management Under the IGCD’s Cost Shared Funding Model (CSFM), $229,500 (GST excl.) was agreed for the development of the Drug and Alcohol Service Planning Model for Australia.

All jurisdictions have contributed much more to the Project than was originally sought, by providing the input from their expert representatives at a series of face-to-face meetings rather than the teleconferences originally proposed. The MHDAO within NSW Ministry of Health met the costs of the meeting venues. A large body of work has also been completed out of session by the Chair and members of the Expert Reference Group. The in-kind contributions have been substantial.

Table 1 - Financial Statement for the Drug and Alcohol Service Planning Model for Australia, April 2010 to March 2013

Income Expenditure Balance

CSFM funding for Years 1 & 2 $229,500

Principal Developer/ Adviser (Apr 2010 to July 2011) - $200,142

NSW Project Team (% salary and on costs; April 2010 to March 2013) - $755,784

Conference facilities (for 1x SC and 9 ERG meetings to 31 Dec 2011) - $18,632

Conference facilities (for 1x SC/ ERG joint meeting and 2 ERG meetings in 2012) - $4,419

Initial data entry for Indigenous adaption to the model and "all peoples" model (contracted) - $3,223

Printing to 31 Dec 2011 - $2,695

Printing from 1 Jan to 2012 to 21 March 2013 - $5,500

May 2011 IGCD - additional funds approved - Information sessions for each jurisdiction ($18,000 approved) $0 $12,000

May 2011 IGCD - additional funds approved - NIDAC Project ($27,500 approved) $0 $20,000

Totals $229,500 $1,022,395 ($792 895)

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8 Model Schema The model uses the NSW population-based planning tool, Mental Health Clinical Care and Prevention (MH-CCP), as its template and follows the same set of principles that guided this first model in NSW (New South Wales Department of Health, 2001). The Drug and Alcohol Service Planning Model for Australia schema (Figure 1; over page) provides a conceptual outline of the model.

There are many inputs into the model. The model’s epidemiology includes the prevalence of substance use disorders by drug type and severity. The Drug and Alcohol Service Planning Model for Australia has three categories of severity - mild, moderate and severe. The division of the mild, moderate and severe groups was informed by the use of disability weights in the Australian Burden of Disease (AusBOD) data. Expert consensus then determined the treatment demand. Drug and age specific care packages were developed, and again expert consensus determined the allocation of individuals to care packages. A care package specifies a level of care that an individual should receive over a 12 month period.

In the development of the model we have specified drug specific care packages that reflect the AusBOD epidemiology. The drug specific care packages that have been developed for the model are alcohol, amphetamine, benzodiazepine, cannabis and illicit opioid care packages.

The model also includes harm reduction services, it also has the functionality to include prevention activities; however, prevention has not been included in this version of the Drug and Alcohol Service Planning Model for Australia.

The model’s outputs are the various estimates of resources required to deliver care over a 12 month period. These outputs include counts of bed or treatment places, bed days, separations, the clinical staff FTE required to deliver the care; counts of prescribed doses of medication, and diagnostic tests.

19

Figure 1 - Drug and Alcohol Service Planning Model for Australia Schema

Child

0-11 months

No Use %

Use, no disorder %

DA-CCP SCHEMA

Standalone Items • Emergency department presentations • Consultation

liaison to MH beds, obstetrics, RACFs

18 - 64 years

Child

1-11 years

65 + years

Disorder %

Alcohol

Amphetamines

Cannabis

Illicit Opiods

Benzodiazipines

Harm reduction

Standalone Items • Emergency department presentations • Care to parents

on behalf of the child

Care Package • NAS baby

12 - 17 years

MILD

prevalence %

MODERATE prevalence %

SEVERE prevalence %

Treated prevalence %

Treated prevalence %

Treated

prevalence 100%

Care Package B

Care Package C etc

Care Package A

Resource predictions FTE, beds, medications

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9 Project Method Crucial to the development of the Drug and Alcohol Service Planning Model for Australia was the guidance provided by the Project’s Expert Reference Group. This group of clinicians, service managers and health planners met frequently and provided guidance to the Project Team.

9.1 THE EPIDEMIOLOGY

The model’s epidemiology is derived from the Australian Burden of Disease (Begg et al, 2007). AusBOD relies on a range of data sources, such as the 1997 National Survey of Mental Health and Wellbeing (NSMHWB) for alcohol, benzodiazepine and cannabis. Data for amphetamines was derived from the National Minimum Data Set - Alcohol and Other Drug Treatment Services (NMDS-AODTS), then a multiplier from McKetin et al (2005) determined the final number of amphetamine closed treatment episodes.

The heroin prevalence rate in the AusBOD data (Begg, et al, 2007) relied on multiple techniques described by Degenhardt et al (2004); however, the AusBOD figure was actually lower than the current number of Australians registered in Opioid Treatment Programs/ Opioid Substitution Program. The ERG revised the AusBOD heroin estimate based on the work of Chamlers et al (2009), and subsequently increased the heroin prevalence rate by approximately double.

The prevalence for alcohol, benzodiazepine and cannabis in the model will be different to that published in the results of the 1997 NSMHWB. This is because AusBOD used DISease MODelling2 (DISMOD2), which is a computer software program developed for the Global Burden of Disease. DISMOD2 allows the user to verify if the assumptions on incidence, prevalence, remission, case fatality rates and observed mortality rates are consisted with one another. This means that the AusBOD generates output prevalence which is different to the prevalence of the 1997 NSMHWB.

Deriving epidemiology for children under 12 years was more difficult, as children less than 12 years are not included in the NSMHWB, nor does the NMDS-AODTS collect or report data for children less than 10 years. Modelling of treatment services for children in this version of the Drug and Alcohol Service Planning Model for Australia is limited, and where required we relied on rates of presentations from the NSW Health Information Exchange (HIE).

9.2 DRUG TYPES

The model covers five drugs: alcohol, cannabis, illicit opioids, amphetamines and benzodiazepines. The drugs that are outside scope include inhalants, ecstasy, tobacco steroids, and pharmaceutical opioid misuse. These are excluded because we do not have population epidemiology for them. Tobacco treatment is covered in the care packages and

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we have modelled a tobacco treatment intervention in the severe care packages for the age groups 18-64 years and 65 years and older. Recognising the prevalence of pharmaceutical opioid misuse, the Expert Reference Group developed care packages, but in the absence of any suitable epidemiology, pharmaceutical opioid misuse is not included in the model. This means that the model does not provide resourcing outputs for pharmaceutical opioid misuse.

9.3 AGE GROUPS

The final age groups included in the model are 0-11 months (baby), 1-11 years (children), 12-17 years (youth), 18-64 years (adult), 65 years and older (mature age).

Determining the age groups for the model is a set of compromises in terms of what epidemiological data we have to drive the model, what makes sense from a clinical perspective in terms of designing care packages, and what is practical in terms of a limited number of age categories so as not to specify an excess of care packages. It helps to keep in mind that the model’s intent is to describe an envelope of resources that are needed to provide clinical care across all ages groups in the population for one year. The table below shows the modelling of care packages by age group and drug type.

Table 2 - Drug Types and Age Groups

Age Categories (- modelled; x - not modelled)

Drug Type

0 - 11 Months

1 - 11 Years

12 - 17 Years

18 - 64 Years

65+ Years

1 Alcohol x x   

2 Amphetamine x x   

3 Benzodiazepines x x   

4 Cannabis x x   

5 Illicit Opioids x x   

All All Drugs   x x x

9.4 TREATMENT NEED AND TREATMENT DEMAND

Although the Drug and Alcohol Service Planning Model for Australia is described as a “should be” model, the reality is that not all patients who meet diagnostic criteria, need or demand treatment. Large population surveys, such as the NSMHWB indicate that many respondents who meet diagnostic criteria also indicate that they did not seek treatment (Slade et al, 2009).

In the most recent 2007 Australian NSMHWB survey, 24% of respondents with substance use disorders used treatment services in the last 12 months (Slade et al, 2009). Self-

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reported service use by people with alcohol dependence was 35.5% in the last 12 months; and 52.4% for drug dependence in the last 12 months (Slade, et al, 2009).

The Expert Reference Group also considered other Australian findings, such as the Tolkien II work (Andrews and the Tolkien II Team, 2007). This body of work reported ideal treatment coverage of 51% (70% for harmful use and 30% for dependence), although this was limited to alcohol only. The Substance Abuse and Mental Health Services Administration (SAMSA) data from the USA reports even lower rates of treatment seeking (United States Department of Health and Human Services. SAMHSA, 2012).

The agreed prevalence, treatment and screening rates by drug type and age group are shown in the following tables.

Table 3 - Alcohol Epidemiology-prevalence and treatment data

ALCOHOL

12-17 years 18-64 years 65+ years

A Standard population (n) 100,000 100,000 100,000

B Not diagnosable (n) 98,939 93,645 98,578

Diagnosable (n) 1,061 6,355 1,422

Division into MILD, MODERATE and SEVERE by prevalence

D MILD 67% 711 4,258 953

E MODERATE 22% 233 1,398 313

F SEVERE 11% 117 699 156

Total 100% 1,061 6,355 1,422

Division into numbers treated by applying Treatment rate

G MILD 20% 142 852 191

H MODERATE 50% 117 699 156

I SEVERE 100% 117 699 156

J Total Treated (n) 376 2,250 503

K Overall Treatment Rate (%) (K = J / C) 35 35 35

L Overall Treatment Rate Of Standard Population (%) (L = J / A) 0.376 2.25 0.503

M At Risk &identified for screening brief intervention, (%) 15.4 15.4 15.4

N Weighted Proportion of age group (%) 8.98 74.86 16.16

O Screening and Brief Intervention (n) 1,369 10,795 2,453

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Table 4 - Amphetamine Epidemiology-prevalence and treatment data

AMPHETAMINE

12-17 years 18-64 years 65+ years

A Standard population (n) 100,000 100,000 100,000

B Not diagnosable (n) 99,873 99,489 99,992

C Diagnosable (n) 127 511 8

Division into MILD, MODERATE and SEVERE by prevalence

D MILD 0% 0 0 0

E MODERATE 10% 13 51 1

F SEVERE 90% 114 460 7

Total (n) 127 511 8

Division into numbers treated by applying Treatment rate

G MILD 0% 0 0 0

H MODERATE 50% 6 26 0

I SEVERE 35% 40 161 3

J Total Treated (n) 46 187 3

K Overall Treatment Rate (%) (K = J / C) 36 37 38

L Overall Treatment Rate Of Standard Population (%) (L = J / A) 0.046 0.187 0.003

M

At Risk &identified for screening brief intervention, (%) 0.9 0.9 0.9

N Weighted Proportion of age group (%) 6.24 77.11 16.65

O Screening and Brief Intervention (n) 56 690 150

Note: the 65 and older age group diagnosable number (n=8) is so small that it affects the calculation of the overall treatment rate (38%). Variation in percentage terms reflect smaller numbers used in the calculation.

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Table 5 - Benzodiazepine Epidemiology-prevalence and treatment data

BENZODIAZEPINE

12-17 years 18-64 years 65+ years

A Standard population (n) 100,000 100,000 100,000

B Not diagnosable (n) 99,987 99,624 99,924

C Diagnosable (n) 13 376 76

Division into MILD, MODERATE and SEVERE by prevalence

D MILD 50% 7 188 38

E MODERATE 30% 4 113 23

F SEVERE 20% 3 75 15

Total (n) 13 376 76

Division into numbers treated by applying Treatment rate

G MILD 20% 1 38 8

H MODERATE 50% 2 56 11

I SEVERE 100% 3 75 15

J Total Treated (n) 6 169 34

K Overall Treatment Rate (%) (K = J / C) 45 45 45

L Overall Treatment Rate Of Standard Population (%) (L = J / A) 0.006 0.169 0.034

Note: At risk - screening and brief intervention is not modelled for Benzodiazepines and Illicit Opioids.

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Table 6 - Cannabis Epidemiology-prevalence and treatment data

CANNABIS

12-17 years 18-64 years 65+ years

A Standard population (n) 100,000 100,000 100,000

B Not diagnosable (n) 99,516 98,235 99,949

C Diagnosable (n) 484 1,765 51

Division into MILD, MODERATE and SEVERE by prevalence

D MILD 67% 324 1,183 34

E MODERATE 22% 106 388 11

F SEVERE 11% 53 194 6

Total (n) 484 1,765 51

Division into numbers treated by applying Treatment rate

G MILD 20% 65 237 7

H MODERATE 50% 53 194 6

I SEVERE 100% 53 194 6

J Total Treated (n) 171 625 18

K Overall Treatment Rate (%) (K = J / C) 35 35 35

L Overall Treatment Rate Of Standard Population (%) (L = J / A) 0.171 0.625 0.018

M At Risk &identified for screening brief intervention, (%) 9.4 9.4 9.4

N Weighted Proportion of age group (%) 8.98 74.86 16.16

O Screening and Brief Intervention (n) 840 6,912 1,518

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Table 7 - Illicit Opioids Epidemiology-prevalence and treatment data

ILLICIT OPIOIDS

12-17 years 18-64 years 65+ years

A Standard population (n) 100,000 100,000 100,000

B Not diagnosable (n) 99,969 99,345 99,893

C Diagnosable (n) 31 655 107

Division into MILD, MODERATE and SEVERE by prevalence

D MILD 0% 0 0 0

E MODERATE 0% 0 0 0

F SEVERE 90% 28 590 96

Total (n) 28 590 96

Division into numbers treated by applying Treatment rate

G MILD 0% 0 0 0

H MODERATE 0% 0 0 0

I SEVERE 100% 28 590 96

J Total Treated (n) 28 590 96

K

Overall Treatment Rate (%) (K = J / C) 90 90 90

L

Overall Treatment Rate Of Standard Population (%) (L = J / A) 0.03 0.59 0.10

Note: At risk - screening and brief intervention is not modelled for Benzodiazepines and Illicit Opioids

9.5 CARE PACKAGES

Care packages were developed by age group, drug type and severity of presentation (mild, moderate, severe) and for 12 years and older. For children 0-11 years, generic “all drug“ care packages were developed.

A care package specifies the care for a person with a specific need for a year. The level of care that is specified in a care package is deemed adequate; anything less is considered inadequate. Care packages are identified for persons who meet the diagnostic criteria for mild, moderate or severe. The terms mild, moderate or severe refer to the level of distress and impairment, not level of AOD use.

Within the care packages various combinations of contacts provided by one of the four types of staff FTEs have been agreed by the Expert Reference Group. Ambulatory care is specified in terms of frequency (occasions of service) and duration of care delivered in the community for an individual e.g. 1x 30 minute assessments. Any bed-based stay is specified in terms of frequency and duration of care with additional data including an average length of stay, and an occupancy rate. Relapse rates and readmission rates are not calculated within the care packages or the Drug and Alcohol Service Planning Model for

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 27

Australia as we did not have specific readmission and relapse data. We have assumed that the readmission is zero, and that relapse is zero. Some care packages may also include prescribed medications and diagnostic tests.

The process of developing all the care packages in the model took over two years. Where required, advice was sought beyond the Expert Reference Group, for example, specialist advice was sought from Celia Wilkins, Curtin University, Western Australia for people aged 65 years and older.

The Drug and Alcohol Service Planning Model for Australia contains 17 sets of care packages. These care packages are an Appendix to the Drug and Alcohol Service Planning Model for Australia -Technical Manual.

9.6 ALLOCATING PATIENTS TO CARE PACKAGES

Where a drug type and age group specifies a mild and a moderate care package, there is only one mild and one moderate care package shown in the model. For example alcohol 18-64 years has only one mild care package, one moderate care package and many severe care packages.

The allocation of individuals to the severe care packages was informed by data from the National Minimum Data Set - Alcohol and Other Drug Treatment Services (NMDS - AODTS). The ERG used the most recent count of closed treatment episodes from the NMDS-AODTS and compared the proportion of closed treatment episodes where the main treatment type was counselling or case management vs. withdrawal vs. rehabilitation. We then used expert opinion to adjust these proportions, for example, the proportion of individuals receiving alcohol withdrawal care packages was increased when compared to the NMDS-AODTS.

9.7 COMPLEX PATIENTS AND CARE PACKAGES

When developing the care packages the Expert Reference Group recognised that for a given care package some people would require more hours of care than others. The distinction between standard and complex is shown in the specification within the severe care packages. In most cases for a given care package, the complex care package will have a longer assessment, more case management and more psychosocial interventions, where required. Complex, as used in this modelling project, reflects the fact that people may be designated as complex because of physical health needs e.g. liver disease, mental health needs e.g. co morbid diagnosis or social circumstances e.g. housing or welfare needs. The allocation of patients to standard vs. complex care packages was typically 70 percent:30 percent.

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9.8 ITEMS THAT ARE NOT 12 MONTH CARE PACKAGES: THE STANDALONE ITEM

Standalone items are not 12 month care packages. The standalone items include: presentations at emergency department (ED), consultation liaison to obstetrics, consultation liaison to residential aged care facility, consultation liaison to mental health beds, or consultation liaison to general beds, where a person has a primary or secondary drug or

alcohol diagnosis.

Standalone items specify an average amount of care provided by drug and alcohol staff e.g. 1 x 30 minute assessment, 2 x 15 minute reviews. The standalone items do not specify any prescription medications or diagnostic tests.

Standalone care is based on actual rates of presentations using NSW HIE data 2010/11. These standalone items are completely separate to the AusBOD epidemiology and the 12 month care packages. For example, the number of ED presentations is not subtracted from the demand for any group in the care packages. These ‘standalone’ items are thus ‘sprinkled’ across the model.

9.9 ITEMS THAT ARE NOT 12 MONTH CARE PACKAGES: PREVENTION

In the original project proposal it was stated that the Drug and Alcohol Service Planning Model for Australia would quantify the need for prevention, promotion and early intervention. It is intended that the model have a comprehensive evidence-based Prevention and Promotion module; underpinned by a sound methodology that aligns with the rest of the model. A recommendation for the progression of this work has been provided to the IGCD for consideration.

9.10 ITEMS THAT ARE NOT 12 MONTH CARE PACKAGES: HARM REDUCTION

Harm reduction services are included in the Drug and Alcohol Service Planning Model. The broad category of services included in the model are: overdose prevention, consumer advocacy services, interventions for intoxication, needle and syringe program. The level of expenditure indicated for each jurisdiction is simply their population weighted share of Australia’s expenditure. Thus if Western Australia represents approximately 10 percent of

Australia’s total population, then the model’s estimate of expenditure for Western Australian harm reduction services is 10 percent of the Australian harm reduction total.

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9.11 ITEMS THAT ARE NOT 12 MONTH CARE PACKAGES: SCREENING AND BRIEF INTERVENTION

At risk -screening and brief intervention has been modelled for alcohol, amphetamines and cannabis. This data was not available for benzodiazepines and illicit opioids.

Table 8 - Screening and brief interventions by drug type and age group

Age Categories

(- included; n/a - not applicable)

Drug Type

0 - 11 Months

1 - 11 Years

12 - 17 Years

18 - 64 Years

65+ Years

1 Alcohol n/a n/a   

2 Amphetamine n/a n/a   

3 Benzodiazepines n/a n/a n/a n/a n/a

4 Cannabis n/a n/a   

5 Illicit Opioids n/a n/a n/a n/a n/a

All All Drugs n/a n/a n/a n/a n/a

9.12 RELAPSE AND READMISSION

In the Drug and Alcohol Service Planning Model for Australia we assume that a patient remains in treatment for the year. Accordingly we have not modelled any readmission to treatment or drop out from treatment.

In the actual Drug and Alcohol Service Planning Estimator Tool, a zero readmission (across drugs and age groups) is modelled. However, as multiplying a number by zero results in a 0 result, the number 1 is used in the formula to represent the zero readmission and keep the remaining factors constant.

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9.13 RESOURCE ESTIMATION: THE COST OF CLINICAL STAFF FTE

The final agreed salaries for the four types of clinical staff FTE modelled in the model are shown in the following table.

Table 9 - Clinical Staff FTE Prices

Clinical Staff Type Base Salary 28% on costs 10%

administration overheads

Total

A B C D E= B +C+D

Doctor - General Practitioner (GP)

NA NA NA $275,000

Doctor - Addiction Medicine Specialist (AMS) $222,503.00 $62,300.84 $22,250.30 $307,054.14

Nurse/Allied Health $81,590.00 $22,845.20 $8,159.00 $112,594.20

AOD worker $59,711.00 $16,719.08 $5,971.10 $82,401.18

The Drug and Alcohol Service Planning Model for Australia-Technical Manual provides an extensive explanation of the assumptions that were used in determining FTE working hours and costs.

9.14 RESOURCE ESTIMATION: DIAGNOSTIC TESTS AND PRESCRIBED MEDICATIONS

We used the Pharmaceutical Benefits Schedule (PBS) prices for the cost of medications. The Project Team then determined price per dose of medication. Medicare prices were used for the diagnostic tests.

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10 In scope and out of scope items 10.1 IN SCOPE

Table 10 - Services in scope

Service

1 The bulk of AOD treatment services such as:

- early interventions

- psychosocial interventions (counselling)

- withdrawal management

- residential rehabilitation

- Inpatient hospital admissions for AOD treatment in a designated D&A bed.

2 Consultation-liaison services delivered by AOD specialist staff to persons with AOD conditions who present in other healthcare settings. E.g. residential aged care facilities, and overnight hospital stays in a mental health bed, general bed, emergency department, or obstetrics bed.

3 AOD services delivered by general practitioners and allied health providers under Medicare.

4 Harm Reduction

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10.2 OUT OF SCOPE

The following services are out of scope for the Drug and Alcohol Service Planning Model for Australia, although it is recognised that they contribute to a successful treatment outcomes.

Table 11 - Services out of scope.

Services Out of Scope

1 Housing/homelessness services

2 Welfare support services, including non AOD outreach services

3 Correctional/crime systems (drug courts, prison-based programs)

4 Youth support services (not AOD specific)

5 No inclusion of co-morbid health services, for example:

- Hepatitis C Virus (HCV) treatment

- Screening in AOD settings for co-morbid health conditions , e.g. Sexually transmitted infections

- Immunisation

- Chronic pain services

6 Alcohol Related Brain Injury (ARBI) or Substance Related Brain Injury (SRBI)

7 Involuntary inpatient/residential patients e.g. those in treatment under the Drug and Alcohol Treatment Act 2007 (NSW) (replaced Inebriates Act)

8 Self-help programs, Alcoholics Anonymous(AA), Narcotics Anonymous (NA)

9 Crisis intervention

10 Internet, online, e-health

11 Peer support programs

12 Supported accommodation

13 Carers/families services that are not AOD specific

14 Poly drug use

15 Co-morbidity - mental health co-morbidity. The model does not include care packages that explicitly integrate AOD with MH services

16 Telephone Services

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11 Results Table 12 - Estimated number of people treated by drug type and severity, 12 years and older, Australia, 2011

Alcohol Amphetamine Benzodiazepine Cannabis Illicit

Opioids Total

12-17 yrs

Mild 2,449 - 22 1,117 - 3,589

Moderate 2,010 109 34 917 - 3,070

Severe 2,010 1,969 45 917 481 5,422

Subtotal 6,470 2078 101 2,951 481 12,081

18-64 yrs

Mild 120,187 - 5,307 33,380 - 158,874

Moderate 98,661 3,606 7,960 27,402 - 137,629

Severe 98,661 64,908 10,613 27,402 83,200 284,784

Subtotal 317,509 68,514 23,880 88,183 83,200 581,287

65+ yrs

Mild 5,943 - 237 213 - 6,393

Moderate 4,879 12 356 175 - 5,422

Severe 4,879 225 474 175 3,004 8,756

Subtotal 15,701 237 1,067 563 3,004 20,571

Total 339,680 70, 830 25,048 91,698 86,684 613,939

A total of 613, 939 people aged 12 years and older are treated in the model. Alcohol accounts for 60 percent of all people aged 12 years and older who are treated

Table 13 - Estimated number of people screened by drug type, 12 years and older, Australia, 2011

Alcohol Amphetamine Benzodiazepine Cannabis Illicit Opioids Total

12-17 yrs 23,850 967 - 14,643 - 39,460

18-64 yrs 1,515,492 61,112 - 970,382 - 2,546,986

65+ yrs 77,913 4,554 - 48,219 - 130,686

Total 1,617,256 66,633 - 1,033,243 - 2,717,132

A total of 2,717,132 people are identified for screening and brief intervention in the model. Alcohol accounts for the largest proportion of people screened and offered a brief intervention (60%), followed by cannabis (38%). Screening and brief intervention were not modelled for benzodiazepines or illicit opioids.

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Table 14 - Estimated number of clinical staff FTEs who provide treatment* by age group, Australia, 2011

Alcohol Amphetamine Benzodiazepine Cannabis

Illicit Opioids All drug Total

0-11 months - - - - - 0.15 0.15

1-11 years - - - - - 17 17

12-17 years 120 65 2 80 74 - 340

18-64 years 5,952 1,159 534 1,547 3,083 - 12,276

65+ years 278 4 24 16 126 - 448

Total 6,350 1,228 560 1,643 3,283 17 13,081

*This is a count of Clinical staff FTEs for the people treated in the mild, moderate and severe groups, and the stand alone items. It excludes clinical staff FTE who offer screening and brief intervention.

A total of 13,081 clinical staff FTEs are estimated to treat people in the mild, moderate and severe groups, all children and the stand alone items. Alcohol accounts for the largest proportion of clinical staff FTEs (49%), followed by opioids (25%) and cannabis (12%).

Table 15 - Estimated number of clinical staff FTEs* who offer screening and brief intervention by age group, Australia, 2011

Alcohol Amphetamine Benzodiazepine Cannabis Illicit Opioids Total

12-17 years 5 - - 3 - 8

18-64 years 324 13 - 207 - 544

65+ years 17 1 - 10 - 28

Total 345 14 - 221 - 580

*This is a count of clinical staff FTEs who offer screening and brief intervention. It excludes people treated in the mild, moderate and severe groups, and the stand alone items.

A total of 580 clinical staff FTEs are estimated to provide screening and brief intervention. Alcohol accounts for the largest proportion of clinical staff FTEs (60%), followed cannabis (38%). Screening and brief intervention were not modelled for benzodiazepines or illicit opioids.

Table 16 - Estimated clinical staff FTEs* by setting, all ages, Australia, 2011

Ambulatory Detoxification Inpatient Residential Rehabilitation Total

NAH 5,596 484 403 19 6,502

AOD 1,632 - - 3,791 5,422

AMS 508 43 35 - 586

GP 439 - - 131 571

Total 8,176 527 438 3,941 13,081

*This is a count of Clinical staff FTEs for the people treated in the mild, moderate and severe groups, and the stand alone

items. It excludes clinical staff FTE who offer screening and brief intervention. The inpatient bed is defined as a specialist drug and alcohol inpatient bed

A total of 13, 081 clinical staff FTEs are estimated to treat people in the mild, moderate and severe groups, and the stand alone items. By setting the greatest proportion of these staff are modelled as working in ambulatory care (63%), followed by residential rehabilitation

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(30%). Nurse/allied health workers make up 50 percent of the estimated workforce, followed by alcohol and other drug workers (41%).

Table 17 - Estimated beds, by bed type and age group, Australia, 2011

Withdrawal Management Inpatient*

Residential

Rehabilitation

Total

12-17 years 12 0 100 112

18-64 years 829 193 5493 6,514

65+ years 28 7 62 97

Total 869 200 5,654 6,723

*The inpatient bed is defined as a specialist drug and alcohol inpatient bed

The Drug and Alcohol Service Planning Model for Australia estimates a total of 6,723 beds. Residential rehabilitation beds represent 84 percent of all beds needed, followed by withdrawal management (13%) and inpatient (3%).

The total estimated expenditure is $2,177,217,219. This is made up of $2,092,820,000 which includes clinical staff FTEs, bed overheads, diagnostic testing and prescription medication. Harm reduction is estimated at $84,397,219 which represents 3.9 percent of the total cost of the model.

Figure 2 - Estimated expenditure all ages, by category, Australia, 2011

(a) Estimated expenditure all ages, by category, Australia, 2011 (b) Estimated expenditure all ages, by jurisdiction, 2011

$1,515.69 , 73%

$147.73 , 7%

$24.92 , 1% $404.48 , 19%

Clinical Staff FTE

Bed overheads

Diagnostic Testing

Prescription Medicine

$675.36 , 32%

$517.27 , 25%

$427.83 , 21%

$214.94 , 10%

$154.67 , 7%

$47.70 , 2% $21.64 , 1% $33.41 , 2%

NSW

VIC

QLD

WA

SA

TAS

NT

ACT

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 37

As expected, in figure 2(a), clinical staff FTE represent the greatest proportion of cost in the model (73%), followed by prescription medicines (19%).

In figure 2(b), the estimated expenditure shown is simply a jurisdiction’s population share of the total Australian expenditure. For example, Western Australia represents 10 percent of the Australian population and is thus shown with an estimated expenditure of $214,940,000.

Figure 3 - Estimated expenditure all ages, by category, Australia, 2011, 2021, 2031

The model can provide estimates of expenditure up to the year 2031. Over the 10 year intervals shown, the model estimates that total Australian expenditure will rise to $2,560,000,000 by 2031. The projected costs are based on increases in the population only. There is no inflation adjustment for the cost of clinical staff FTEs, bed overheads, prescribed medications and diagnostic tests.

$-

$200.00

$400.00

$600.00

$800.00

$1,000.00

$1,200.00

$1,400.00

$1,600.00

$1,800.00

$2,000.00

Clinical Staff FTE Bed overheads Diagnostic Testing

Prescription Medicine

2011

2021

2031

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 38

Figure 4 - Estimated expenditure 12 years and older, by drug type, Australia, 2011

Alcohol represents the largest proportion (46%) of expenditure by drug type at $967,110,000 followed by opioids, $695,910,000 (33%). The remaining three drug types represent 21 percent of the total expenditure. The total expenditure for children aged 0-11 months and 1-11 years is estimated to be $1,890,000.

$967.11 , 46%

$138.36 , 7%

$99.21 , 5%

$190.35 , 9%

$695.91 , 33%

Alcohol

Amphetamine

Benzodiazepine

Cannabis

Opioids

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Figure 5 - Estimated expenditure 12 years and older, by severity, Australia 2011.

Severe represents the largest proportion (92%) of expenditure by severity at $1,463,230,000. The estimated expenditure for mild is $19,690,000 (1%).

The Drug and Alcohol Service Planning Model for Australia - Estimator Tool contains 15 standard reports, and also allows users to customise additional reports. Copies of the standard reports are included in the appendix to this report.

$1,463.23 , 92%

$19.69 , 1%

$99.16 , 6% $14.14 , 1%

Severe

Mild

Mod

Mild-Moderate

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12 Discussion

The results from the first Drug and Alcohol Services Planning Model for Australia estimate total expenditure for the reference year 2011 at $2,177,217,219 This figure represents $2,092,820,000 for clinical staff FTEs, prescription medication, diagnostic test and bed overheads. Harm reduction interventions are estimated at $84,397,219 which is 3.9 percent of the total cost of the model.

Of the five drug types included in the Drug and Alcohol Service Planning Model for Australia, alcohol accounts for the greatest proportion of expenditure (46%) for the mild, moderate and severe groups.

Andrews and the Tolkien II Team (2007) estimated a range of cost regarding alcohol harmful use and alcohol dependence only. This range reflects different modelling scenarios. Using data for current coverage, Tolkien II estimated expenditure of $73,000,000. Data for ideal coverage and ideal mix of interventions was estimated at $173,000,000, while optimal coverage and optimal interventions estimated a cost of $258,000,000.

The variation in predicted expenditure by the two models reflects a range of factors. Tolkien II costs are in 1997 dollars and do not include vocational rehabilitation, administration, infrastructure or non salary running costs. Both the Drug and Alcohol Service Planning Model for Australia and Tolkien II include the cost of medications, accommodation days and clinical staff FTEs. It can also be reasonably assumed that the medications specified in Tolkien II, the accommodation days, the types of clinical staff FTEs are different to those in this model. Further the costing applied to these common items are different.

As expected, clinical staff FTEs represent the greatest proportional cost in the model (73%, $1,515,690,000) followed by prescribed medications (19%, $404,480,000). As expected, analysis by drug type shows that alcohol alone accounts for 46 percent of the Australian treatments costs ($967,110,000) followed by opioids (33%, $695,910,000).

Again, as expected, treatment costs for the severe group account for 92 percent ($1,463,230,000) of the total Australian expenditure estimated by the model Estimated expenditure on children aged 0-11 years was low at $1,890,000 as compared to 12 years and older. There is little epidemiology regarding children, and the care packages developed by the ERG for children were few. Future revisions of the Drug and Alcohol Service Planning Model for Australia could include more care for children.

The current model uses AusBOD data which in turn relies on the 1997 National Survey of Mental Health and Wellbeing (NSMHWB) for alcohol, cannabis and benzodiazepine. The more recent 2007 NSMHWB survey indicates that the number of young female Australians diagnosed with symptoms of alcohol abuse increased by 27,000 (Slade et al, 2010). Thus, it could be reasonably argued that the current model under-represents a “should be” level of treatment and the associated outputs: clinical staff FTEs, treatment places, and expenditure for alcohol in particular and for the model in general.

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The Drug and Alcohol Service Planning Model estimates a total of 13,661 clinical staff FTEs for all ages to meet the drug and alcohol services need of Australians for the reference year 2011. Of this total, 13,081 clinical staff FTEs are estimated for all ages to deliver the 12 month care packages, and the consultation liaison standalone items. A total of 580 staff are estimated to deliver the screening and brief intervention.

The NMDS-AODTS does not collect or report any data regarding the drug and alcohol workforce. In the absence of any routine national data collections we can only state that we believe the estimates for FTEs are reasonable. In 2002, the National Centre for Education and Training on Addiction (NCETA) (Wollinski, et al 2003) conducted a survey of the drug and alcohol workforce. This survey represented 318 of 486 active specialist AOD treatment services in the Clients of Treatment Service Agencies (COTSA); response rate 65 percent, The sampling frame represents 549 AOD Federal, State and Territory government, non government and private treatment agencies The actual reported total staff (not FTEs) was 6,668 which was then extrapolated to a total (adjusted) 10,190 staff (not FTEs) to represent the sampling frame. Of the 6668 staff, 4690 were therapeutic staff, 167 alcohol specific and 1811 as other. If we exclude the “other” staff, the adjusted total “frontline” staff (not FTEs) is 7422.

Further data from a 2005 NCETA survey (Duraisingham et al 2006) using the same COTSA sampling framework indicated that the Australian drug and alcohol ‘frontline” workforce was comprised of 70 percent full time workers and 30 percent part time workers, response rate 38 percent. Using the findings of both surveys, it is possible to calculate the survey’s FTE frontline staff is 5195 (70%*7422*1) and the remaining part time frontline FTE staff is 1113 (30% *7422*0.5). Thus the survey’s total FTE frontline staff is 6308.

Comparing the Drug and Alcohol Service Planning Model for Australia FTE count for the severe category with the COTSA sampling frame of active specialist AOD treatment services, it could be argued that the model’s estimate of 11 507 clinical staff FTEs who deliver care to patients in the severe group is reasonable, given the time that has elapsed from the NCETA survey of 2002 and the model’s estimates of staff needed for the year 2011

Particular caution is required when comparing the number of people who report receiving treatment compared with those who should receive treatment. The Substance Abuse and Mental Health Services Administration (SAMSHA, 2012) in the USA reports that only 1.5% of the population aged 12 years or older received drug and alcohol treatment. While the figure of 1.5% appears low it is important to keep in mind that the SAMSHA denominator is not the actual number of people who are dependent and should receive treatment, instead it is the general population. In other words SAMSHA’s denominator is the entire population and includes those who do not use drugs and alcohol , those who use drugs and alcohol and who are not diagnostically ill (e.g. no harmful use, not dependent) and those who are diagnostically ill (dependent/harmful use ) and do not perceive a need for treatment.

The Drug and Alcohol Service Planning Model for Australia has an overall treatment rate of 35% for alcohol. This means that 35% of the diagnostically ill (dependent/harmful use) are treated in the model. Using alcohol 18-64 as an example, then 2,250 people per 100,000 are treated in the model. This represents 2.25% of the population ‘should be’ treated. Australia and the USA also have different health/treatment systems.

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In the AusBOD data the estimates of prevalence and service demand in the model for the major illicit drugs, opiates and amphetamines are based on indirect estimation methods that have not been evaluated outside NSW or in recent years. The Drug and Alcohol Service Planning Model for Australia is a model of averages. Since usage varies a great deal between places and over time jurisdictions may wish to adjust the epidemiology to reflect local conditions. The two examples below illustrate why jurisdictions may wish to adjust the model’s epidemiology.

The most recent National Drug Strategy Household Survey (ABS, 2011) indicates that methamphetamine/ amphetamine use in the last 12 months by people aged 12 years and older is 2.1 percent across Australia, 1.6 percent in NSW and 3.4 percent in Western Australia. While the actual percentages may appear to be low, they do illustrate that methamphetamine/amphetamine use in Western Australia is 1.6 times that of the Australian rate, while NSW is approximately three-quarters of the Australian rate.

Similarly the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) data for 2011 (AIHW, 2012) indicates that the number of clients registered in opioid pharmacotherapy programs is 2.1 clients per 1,000 population across Australia, 1.4 clients per 1,000 population in Western Australia, and 2.5 clients per 1,000 population in NSW. Again, the actual percentages may appear to be low, but they reinforce that rate of clients registered in opioid pharmacotherapy in NSW is approximately 1.2 times that of the Australian rate, while Western Australia is approximately two-thirds of the Australian rate.

The current NMDS-AODTS has been of very limited assistance to the inputs of the Drug and Alcohol Service Planning Model for Australia. It was used only to inform the initial distribution of people to the severe care packages. It is well known that the current NMDS-AODTS provides a count of closed treatment episodes, not a count of unique individuals who sought treatment.

The Drug and Alcohol Service Model produces many outputs, and these outputs are used in any gap analysis. The outputs include estimate number clinical staff FTEs needed, estimated expenditure, and estimated numbers of patients to be treated. Any current gap analysis is most likely to be based on expenditure.

The Drug and Alcohol Service Planning Model for Australia relied heavily on data from the NSW HIE. The NSW HIE was the source for determining the overhead costs related to inpatient and withdrawal management bed-based stays included in the model, as well as inpatient average lengths of stay. In determining the overhead costs for the inpatient and withdrawal bed-based stays, the data was drawn from four different wards that reported as dual diagnosis units. Overhead costs for residential rehabilitation stays relied upon a report commissioned by NSW Health (Health Policy Analysis, 2005). We could not provide any overhead costs related to ambulatory care as this data simply is not collected. Salaries for FTEs were guided by early data obtained from the NSW HIE again, with additional input provided by ERG members.

The Drug and Alcohol Service Planning Model for Australia will need review as new epidemiology, treatments or services become available. Unlike mental health epidemiology, which is largely stable over time, the prevalence of substance use conditions, particularly those related to illicit drugs, is affected by supply factors, some of which are the subject of

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 43

law enforcement activity and government policy. Recognising the prevalence of pharmaceutical opioid misuse, the ERG developed care packages, but in the absence of any suitable epidemiology, pharmaceutical opioid misuse is not included in the model. This means that the model does not provide resourcing outputs for pharmaceutical opioid misuse. The NIDAC has developed Indigenous care packages, which is one of the most critical pieces to the development of an Indigenous specific drug and alcohol planning model.

The Drug and Alcohol Service Planning Model for Australia is Australia’s first model for drug and alcohol service planning. We have described the services and activities that have been included in this model, and those that have not. These details will provide a useful starting point for further revisions of the model

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Model 44

13 Conclusion The purpose of the Project was to develop a population-based model for drug and alcohol service planning in Australia. The Project’s objective was to estimate the resources needed in a population-based model for drug and alcohol service planning in Australia (e.g. FTE staff per 100,000 population, and beds per 100,000 population).

In completing this body of work we have:

• Provided the tools, the Drug and Alcohol Service Planning Model for Australia- Estimator Tool (Excel format) and supporting information, the Estimator Tool User Guide, and a comprehensive Technical Manual; for Australia’s first drug and alcohol service planning model. • Stated that the outputs of the Drug and Alcohol Service Planning Model for Australia -

Estimator Tool are primarily intended to describe the envelope of resources estimated to meet the drug and alcohol needs of Australia. That said, the model can also inform target-setting for services or monitoring service development. In this case a jurisdiction may wish to building up resources to meet a certain percentage of treatment places, beds or clinical staff FTE needed. The outputs of the model may also encourage debate regarding how planning drug and alcohol services should be undertaken, how resources should be distributed or re distributed. • Described the limited alignment of the model’s inputs and outputs in relation to the

NMDS-AODTS, particularly in regard to the number of clinical staff FTEs who comprise the drug and alcohol workforce, the expenditure on salaries and non salary items, and data regarding the amount of clinical care that a unique patient receives in a year. • Stated that the Drug and Alcohol Service Planning Model for Australia is a model of

averages. Since usage varies a great deal between places and over time jurisdictions may wish to adjust the epidemiology to reflect local conditions. • Detailed the services and activities included in this version of the Drug and Alcohol Service Planning Model, and those services and activities that are not included. This

information serves as a prudent starting point for future revisions of this model.

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 45

14 References Andrews and the Tolkien II Team, 2007 Tolkien II: A Needs-based, Costed Stepped-care Model for Mental Health Services. Sydney: World Health Organization Collaborating Centre for Classification in Mental Health.

Australian Institute of Health and Welfare 2012. National Opioid Pharmacotherapy Statistics Annual Data collection: 2011 report. Drug treatment series no. 15. Cat. no. HSE 121. Canberra: AIHW.

Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. No. PHE 145. Canberra: AIHW.

Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L., & Lopez, A. (2007). The burden of disease and injury in Australia 2003: PHE 82. Canberra: Australian Institute of Health and Welfare.

Chalmers, J., Ritter, A., Heffernan, M., & McDonnell, G. (2009). Modelling Pharmacotherapy Maintenance in Australia; Exploring affordability, availability, acessibility and quality using system dynamics. Canberra: ANCD Research Paper No 19. Australian National Council on Drugs.

Degenhardt, L., Rendle, V., Hall, W., Gilmour, S., & Law, M. G. (2004). Estimating the number of current regular heroin users in NSW and Australian 1997-2002. Technical Report 198. Sydney, Australia: National Drug and Alcohol Research Centre, UNSW.

Duraisingham, V; Pidd, K; Roche, A M; &O’Connor, J. (2006) Stress, satisfaction and retention among alcohol and other drug workers in Australia. Adelaide. National Centre for Education and Training on Addiction.

Health Policy Analysis (2005) NSW Alcohol and Drug Residential Rehabilitation Costing Study - report prepared for NSW centre for Drug and Alcohol, NSW Department of Health.

McKetin, R., McLaren, J., Kelly, E., Hall, W., & Hickman, M. (2005). Estimating the number of regular and dependent methamphetamine users in Australia. NDARC Technical Report No. 230. . Sydney: National Drug & Alcohol Research Centre.

New South Wales Department of Health. (2001). Mental Health Clinical Care and Prevention Model: a population health model MH-CCP Version1.11.

http://www0.health.nsw.gov.au/mhdao/planning_evaluation.asp Sydney: New South Wales Department of Health.

Pirkis, J., Harris, M., Buckingham, W., Whiteford, H., & Townsend-White, C. (2007). International planning directions for provision of mental health services. Administration and Policy in Mental Health, 34(4), 377-387.

Slade, T., Teesson, M., Mills, K. (2010). Trends over time in alcohol use and alcohol use disorders: results of the National Surveys of Mental Health and Wellbeing. Findings presented at the National Drug and Alcohol Research Centre Annual Symposium, 2010. Sydney, Australia.

Substance Abuse and Mental Health Services Administration. SAMHSA . (2012), Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings,

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 46

NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

Slade, T., Johnston, A., Teesson, M., Whiteford, H., Burgess, P., Prirkis, J., et al. (2009). The Mental Health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Canberra: Department of Helath and Ageing

Wollinski, K; O’Neill, M; Roche, A M; Freeman, T; & Donald, A (2003) Workforce issue and the treatment of alcohol problems: A survey of managers of Drug and Alcohol Services. Canberra. Australian Government Department of Health and Ageing.

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 47

15 Tables & Figures 15.1 LIST OF TABLES

Table 1 - Financial Statement for the project, April 2010 to March 2013 .......................... 17

Table 2 - Drug Types and Age Groups ............................................................................ 21

Table 3 - Alcohol Epidemiology-prevalence and treatment data ....................................... 22

Table 4 - Amphetamine Epidemiology-prevalence and treatment data ............................ 23

Table 5 - Benzodiazepine Epidemiology-prevalence and treatment data ......................... 24

Table 6 - Cannabis Epidemiology-prevalence and treatment data ................................... 25

Table 7 - Illicit Opioids Epidemiology-prevalence and treatment data .............................. 26

Table 8 - Screening and brief interventions by drug type and age group .......................... 29

Table 9 - Clinical Staff FTE Prices ................................................................................... 30

Table 10 - Services in scope .............................................................................................. 32

Table 11 - Services out of scope. ....................................................................................... 33

Table 12 - Estimated number of people treated by drug type and severity, 12 years and older, Australia, 2011 ........................................................................................ 34

Table 13 - Estimated number of people screened by drug type, 12 years and older, Australia, 2011 .................................................................................................. 34

Table 14 - Estimated number of clinical staff FTEs who provide treatment* by age group, Australia, 2011 .................................................................................................. 35

Table 15 - Estimated number of clinical staff FTEs* who offer screening and brief intervention by age group, Australia, 2011 ........................................................ 35

Table 16 - Estimated clinical staff FTEs* by setting, all ages, Australia, 2011 .................... 35

Table 17 - Estimated beds, by bed type and age group, Australia, 2011 ............................ 36

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 48

15.2 LIST OF FIGURES

Figure 1 - Drug and Alcohol Service Planning Model for Australia Schema ......................... 19

Figure 2 - Estimated expenditure all ages, by category, Australia, 2011.............................. 36

Figure 3 - Estimated expenditure all ages, by category, Australia, 2011, 2021, 2031 .......... 37

Figure 4 - Estimated expenditure 12 years and older, by drug type, Australia, 2011 ........... 38

Figure 5 - Estimated expenditure 12 years and older, by severity, Australia 2011. .............. 39

A project commissioned by the Ministerial Council on Drug Strategy through the Cost Shared Funding Mode 49

16 Appendix 1 - Estimator Tool Standard Reports

Summary Report 1a - Prevalence and treatment rates by age category Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Year 2011

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids

Summary 12-17 A. Standard population 100,000 100,000 100,000 100,000 100,000

B. Diagnosable rate / 100k 1,061 127 13 484 31

C. Severe diagnosis rate / 100k 117 114 3 53 28

D. Moderate diagnosis / 100k 233 13 4 106

E. Mild diagnosis / 100k 711 7 324

F. Total treatment % share of diagnosable 35% 37% 45% 35% 90%

G. Total treatment number / 100k 376 46 6 171 28

H. Severe treatment number / 100k 117 40 3 53 28

I. Moderate treatment number / 100k 117 6 2 53

J. Mild treatment number / 100k 142 1 65

K. Screening & brief intervention / 100k 1,385 56 850

L. Selected jurisdiction population 1,722,518 1,722,518 1,722,518 1,722,518 1,722,518

M. Diagnosable for selected population 18,276 2,188 224 8,337 534

N. Severe diagnosis number for selected popn 2,010 1,969 45 917 481

O. Moderate diagnosis number for selected popn 4,021 219 67 1,834

P. Mild diagnosis number for selected popn 12,245 112 5,586

Q. Total treatment number for selected popn 6,470 798 101 2,951 481

R. Severe treatment number, selected popn 2,010 1,969 45 917 481

S. Moderate treatment number, selected popn 2,010 109 34 917

T. Mild treatment number, selected popn 2,449 22 1,117

U. Screening & brief intervention number, selected popn 23,850 967 14,643

18-64 A. Standard population 100,000 100,000 100,000 100,000 100,000

B. Diagnosable rate / 100k 6,355 511 376 1,765 655

C. Severe diagnosis rate / 100k 699 460 75 194 590

D. Moderate diagnosis / 100k 1,398 51 113 388

E. Mild diagnosis / 100k 4,258 188 1,183

F. Total treatment % share of diagnosable 35% 37% 45% 35% 90%

G. Total treatment number / 100k 2,250 187 169 625 590

H. Severe treatment number / 100k 699 161 75 194 590

I. Moderate treatment number / 100k 699 26 56 194

J. Mild treatment number / 100k 852 38 237

K. Screening & brief intervention / 100k 10,738 433 6,876

L. Selected jurisdiction population 14,113,597 14,113,597 14,113,597 14,113,597 14,113,597

M. Diagnosable for selected population 896,919 72,120 53,067 249,105 92,444

N. Severe diagnosis number for selected popn 98,661 64,908 10,613 27,402 83,200

O. Moderate diagnosis number for selected popn 197,322 7,212 15,920 54,803

P. Mild diagnosis number for selected popn 600,936 26,534 166,900

Q. Total treatment number for selected popn 317,509 26,324 23,880 88,183 83,200

R. Severe treatment number, selected popn 98,661 64,908 10,613 27,402 83,200

S. Moderate treatment number, selected popn 98,661 3,606 7,960 27,402

T. Mild treatment number, selected popn 120,187 5,307 33,380

U. Screening & brief intervention number, selected popn 1,515,492 61,112 970,382

65+ A. Standard population 100,000 100,000 100,000 100,000 100,000

B. Diagnosable rate / 100k 1,422 8 76 51 107

C. Severe diagnosis rate / 100k 156 7 15 6 96

D. Moderate diagnosis / 100k 313 1 23 11

E. Mild diagnosis / 100k 953 38 34

F. Total treatment % share of diagnosable 35% 37% 45% 35% 90%

G. Total treatment number / 100k 503 3 34 18 96

H. Severe treatment number / 100k 156 3 15 6 96

I. Moderate treatment number / 100k 156 0 11 6

J. Mild treatment number / 100k 191 8 7

K. Screening & brief intervention / 100k 2,498 146 1,546

L. Selected jurisdiction population 3,119,026 3,119,026 3,119,026 3,119,026 3,119,026

M. Diagnosable for selected population 44,353 250 2,370 1,591 3,337

N. Severe diagnosis number for selected popn 4,879 225 474 175 3,004

O. Moderate diagnosis number for selected popn 9,758 25 711 350

P. Mild diagnosis number for selected popn 29,716 1,185 1,066

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Q. Total treatment number for selected popn 15,701 91 1,067 563 3,004

R. Severe treatment number, selected popn 4,879 225 474 175 3,004

S. Moderate treatment number, selected popn 4,879 12 356 175

T. Mild treatment number, selected popn 5,943 237 213

U. Screening & brief intervention number, selected popn 77,913 4,554 48,219

©NSW Ministry of Health 2013.

Summary Report 1b - Total annual occupied bed days and separations Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Year 2011

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids

Resources per 100k population Occupied bed days 12-17 731 546 586 771

18-64 11,038 2,814 83 3,411 3,397

65+ 1,108 15 24 88

Separations 12-17 20 14 16 21

18-64 307 54 11 69 81

65+ 53 1 1 6

Resources for selected population Occupied bed days 12-17 12,595 9,406 10,091 13,288

18-64 1,557,918 397,207 11,781 481,349 479,413

65+ 34,567 477 759 2,733

Separations 12-17 352 241 271 360

18-64 43,312 7,679 1,592 9,700 11,398

65+ 1,651 24 24 180

Notes to Report 1a and 1b 1. Total treatment number for each drug includes varied % treated for persons diagnosed severe, mild or moderate 2. 'Selected popn' refers to the population jurisdiction selected in the 'PopulationSelector' of the DA-CCP model 3. Projections apply to population only. No adjustment is made for inflation. Only years 2011-2026, 2031 are viewable 4. If Prevalence rates have been altered from standard then the model no longer complies with the national standard methodology 5. Due to rounding, some numbers in the tables above may not add exactly to the totals

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Summary Report 2a - Treatment resources - number of FTEs and beds Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Year 2011

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids All-child Grand Total

0-11mnths Summary Treatment popn + SBI + Standalone popn - - - - - 100 100

Resources for selected population Clinical Staff FTE - - - - - 0.15 0.15

1-11 Summary Treatment popn + SBI + Standalone popn - - - - - 9,769 9,769

Resources for selected population Clinical Staff FTE - - - - - 16.60 16.60

12-17 Summary Treatment popn + SBI + Standalone popn 39,010 2,193 320 20,593 675 - 62,791

Resources for selected population Clinical Staff FTE 119.9 64.6 1.8 79.9 74.1 - 340.3

Beds 31.2 23.1 - 24.9 32.8 - 112.0

18-64 Summary Treatment popn + SBI + Standalone popn 1,962,931 95,763 27,750 1,083,009 101,999 - 3,271,453

Resources for selected population Clinical Staff FTE 5,952.0 1,159.3 534.2 1,547.2 3,082.9 - 12,275.7

Beds 3,741.4 749.7 37.1 911.4 1,074.7 - 6,514.3

65+ Summary Treatment popn + SBI + Standalone popn 112,369 4,717 2,024 48,896 3,849 - 171,853

Resources for selected population Clinical Staff FTE 277.7 4.3 24.3 15.6 126.2 - 448.1

Beds 85.7 0.4 - 1.5 9.4 - 97.0

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Summary of all ages Year 2011

Age (All)

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids All-child Grand Total

Summary Treatment population 339,680 27,214 25,048 91,698 86,684 - 570,322

Treatment popn + SBI + Standalone popn 2,114,310 102,672 30,094 1,152,498 106,523 9,870 3,515,967

Resources for selected population Clinical Staff FTE 6,350 1,228 560 1,643 3,283 17 13,081

Beds 3,858 773 37 938 1,117 - 6,723

Notes 1. Small numbers may display as '0.00'. Absolute zero will display as dash '-' 2. 'Selected population' refers to the total number of people in each age group in Australia 3. 'Treatment population' refers to the total number of persons diagnosed and requiring treatment, including Severe, Moderate, Mild only 4. SBI refers to Screening and Brief Intervention population. Standalone popn refers to a variety of services that are distributed across care packages 5. Total Clinical Staff FTE numbers includes all services for Mild, Moderate, Severe, Screening, Brief Intervention and Stand Alone items. 6. Projections apply to population only, with cost projection scaled to population projections. There is no inflation adjustment for the cost of clinical Staff FTEs, bed overheads, prescription medicines or diagnostic tests. Only years 2011-2026, 2031 are viewable

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

7. Diagnostic Testing and Prescription Medicine cannot be shown as 'resources' at this level as they contain incommensurate doses 8. FTE refers to Full Time Equivalent clinical staff. Resources refers to a count of FTEs and beds (annual estimated requirement)

©NSW Ministry of Health 2013.

Report 2b - Staff numbers by type and cost for all drugs, select years Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug (All)

Age (All)

Sum of TOTAL Column Labels

Row Labels 2011 2016 2021 2026 2031

Resources per 100k population 122.50 122.51 122.51 122.51 122.51

Clinical Staff FTE NAH 62.24 62.24 62.24 62.24 62.25

AOD 50.23 50.23 50.23 50.23 50.23

AMS 5.31 5.31 5.31 5.31 5.31

GP 4.74 4.74 4.74 4.74 4.74

Resources for selected population 13,080.96 13,852.67 14,582.14 15,276.35 15,986.46

Clinical Staff FTE NAH 6,502.25 6,895.51 7,266.71 7,621.92 7,985.00

AOD 5,422.34 5,728.78 6,019.71 6,294.30 6,575.61

AMS 585.67 623.13 658.34 692.19 726.58

GP 570.70 605.25 637.39 667.94 699.27

Clinical Staff FTE resources by (All) drugs, (All) ages, 2011

6,502.25

5,422.34

585.67 570.70

Clinical Staff FTE resources by (All) drugs, (All) ages, 2011

NAH

AOD

AMS

GP

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

SBI (screening and brief intervention) as share of service population and total FTE Clinical Resources Year 2011

Age (All)

Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids All-child Grand Total

Summary Treatment popn + SBI + Standalone popn Sum of TOTAL 2,114,310 102,672 30,094 1,152,498 106,523 9,870 3,515,967

Sum of At Risk - Screen, Brief Interv. 1,617,256 66,633 - 1,033,243 - - 2,717,132

Resources for selected population Clinical Staff FTE Sum of TOTAL 6,350 1,228 560 1,643 3,283 17 13,081

Sum of At Risk - Screen, Brief Interv. 345 14 - 221 - - 580

At Risk - Screeening and brief intervention As share of service population % 76.5% 64.9% 0.0% 89.7% 77.3%

As share of total FTE resources % 5.4% 1.2% 0.0% 13.4% 4.4%

i.e. SBI is a large share of the total population that is serviced, but a very small share of staffing demand. SBI is not a 'treatment' component of the model.

Notes to Report 2a and 2b

6,502.25

5,422.34

AOD

AMS

GP

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

1. Total treatment number for each drug includes varied % treated for persons diagnosed severe, mild or moderate 2. 'Selected popn' refers to the population jurisdiction selected in the 'PopulationSelector' of the DA-CCP model 3. Projections apply to population only. No adjustment is made for inflation. Only years 2011-2026, 2031 are viewable 4. If Prevalence rates have been altered from standard then the model no longer complies with the national standard methodology 5. Due to rounding, some numbers in the tables above may not add exactly to the totals 6. Small numbers may display as '0.00'. Absolute zero will display as dash '-'

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013 DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Summary Report 3 - Treatment resource costs for selected population Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Year 2011

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids All-child Grand Total

0-11mnths Summary - - - - - 100 100

Treatment popn + SBI + Standalone popn - - - - - 100 100

Cost for selected popn $mill - - - - - 0.017 0.017

Clinical Staff FTE - - - - - 0.017 0.017

1-11 Summary - - - - - 9,769 9,769

Treatment popn + SBI + Standalone popn - - - - - 9,769 9,769

Cost for selected popn $mill - - - - - 1.869 1.869

Clinical Staff FTE - - - - - 1.869 1.869

12-17 Summary 39,010 2,193 320 20,593 675 - 62,791

Treatment popn + SBI + Standalone popn 39,010 2,193 320 20,593 675 - 62,791

Cost for selected popn $mill 12.84 $ 7.17 $ 0.29 $ 8.56 $ 8.52 $ - $ 37.38 $

Clinical Staff FTE 12.21 $ 6.68 $ 0.27 $ 8.06 $ 7.54 $ - $ 34.76 $

Bed overheads 0.62 $ 0.43 $ - $ 0.48 $ 0.64 $ - $ 2.17 $

Diagnostic Testing 0.02 $ 0.05 $ 0.01 $ 0.02 $ 0.06 $ - $ 0.15 $

Prescription Medicine 0.00 $ 0.00 $ 0.02 $ - $ 0.27 $ - $ 0.29 $

18-64 Summary 1,962,931 95,763 27,750 1,083,009 101,999 - 3,271,453

Treatment popn + SBI + Standalone popn 1,962,931 95,763 27,750 1,083,009 101,999 - 3,271,453

Cost for selected popn $mill 912.16 $ 130.71 $ 94.52 $ 179.99 $ 658.89 $ - $ 1,976.27 $

Clinical Staff FTE 669.73 $ 113.57 $ 81.17 $ 159.05 $ 397.69 $ - $ 1,421.21 $

Bed overheads 85.36 $ 14.33 $ 2.47 $ 17.76 $ 22.44 $ - $ 142.37 $

Diagnostic Testing 4.34 $ 0.35 $ 2.66 $ 0.24 $ 16.09 $ - $ 23.67 $

Prescription Medicine 152.73 $ 2.46 $ 8.22 $ 2.94 $ 222.67 $ - $ 389.02 $

65+ Summary 112,369 4,717 2,024 48,896 3,849 - 171,853

Treatment popn + SBI + Standalone popn 112,369 4,717 2,024 48,896 3,849 - 171,853

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Treatment popn + SBI + Standalone popn 112,369 4,717 2,024 48,896 3,849 - 171,853

Cost for selected popn $mill 42.10 $ 0.49 $ 4.39 $ 1.80 $ 28.50 $ - $ 77.28 $

Clinical Staff FTE 34.46 $ 0.45 $ 3.91 $ 1.74 $ 17.28 $ - $ 57.84 $

Bed overheads 2.82 $ 0.02 $ - $ 0.04 $ 0.30 $ - $ 3.19 $

Diagnostic Testing 0.23 $ 0.00 $ 0.12 $ 0.00 $ 0.74 $ - $ 1.10 $

Prescription Medicine 4.59 $ 0.01 $ 0.37 $ 0.02 $ 10.17 $ - $ 15.16 $

Year 2011

Sum of TOTAL Column Labels

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids All-child Grand Total

Cost for selected popn $mill Clinical Staff FTE 716.39 $ 120.70 $ 85.35 $ 168.85 $ 422.52 $ 1.89 $ 1,515.69 $

Bed overheads 88.80 $ 14.79 $ 2.47 $ 18.28 $ 23.39 $ - $ 147.73 $

Diagnostic Testing 4.59 $ 0.40 $ 2.78 $ 0.26 $ 16.89 $ - $ 24.92 $

Prescription Medicine 157.32 $ 2.47 $ 8.61 $ 2.96 $ 233.11 $ - $ 404.48 $

Cost for selected popn $mill Total 967.11 $ 138.36 $ 99.21 $ 190.35 $ 695.91 $ 1.89 $ 2,092.82 $

Notes 1. Small numbers may display as '0.00'. Absolute zero will display as dash '-' 2. Selected population refers to the total number of people in each age group in Australia 3. Treatment population is total persons requiring treatment including Severe, mild, moderate only 4. Treatment popn + SBI + Standalone popn includes diagnosed treated, plus Screening and Brief Intervention and Standalone items 5. Total Clinical Staff FTE numbers includes all services for Mild, Moderate, Severe, Screening, Brief Intervention and Stand Alone items. 6. Projections apply to population only, with cost projection scaled to population projections. There is no inflation adjustment for the cost of clinical Staff FTEs, bed overheads, prescription medicines or diagnostic tests. Only years 2011-2026, 2031 are viewable

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Summary Report 4 - Resource demand and cost by single drug type Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Year 2011

Values

Row Labels

Sum of TOTAL

Sum of SEVERE

Sum of At Risk - Screen, Brief Interv. Sum of mild

amb

Sum of mod amb Sum of mild-mod amb

12-17 1,761,692 136 23,856 2,452 2,029 -

Summary 1,761,528 - 23,850 2,449 2,010 -

Selected jurisdiction population 1,722,518 - - - - -

Treatment popn + SBI + Standalone popn 39,010 - 23,850 2,449 2,010 -

Resources for selected population 151 126 5 3 17 -

Clinical Staff FTE 120 95 5 3 17 -

Beds 31 31 - - - -

Cost for selected popn $mill 12.83 $ 9.98 $ 0.57 $ 0.34 $ 1.93 $ - $

Clinical Staff FTE 12.21 $ 9.36 $ 0.57 $ 0.34 $ 1.93 $ - $

Bed overheads 0.62 $ 0.62 $ - $ - $ - $ - $

18-64 16,086,977 9,370 1,515,852 120,330 99,237 -

Summary 16,076,528 - 1,515,492 120,187 98,661 -

Selected jurisdiction population 14,113,597 - - - - -

Treatment popn + SBI + Standalone popn 1,962,931 - 1,515,492 120,187 98,661 -

Resources for selected population 9,693 8,737 324 128 505 -

Clinical Staff FTE 5,952 4,995 324 128 505 -

Beds 3,741 3,741 - - - -

Cost for selected popn $mill 755.09 $ 633.75 $ 36.43 $ 14.45 $ 70.47 $ - $

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Cost for selected popn $mill 755.09 $ 633.75 $ 36.43 $ 14.45 $ 70.47 $ - $

Clinical Staff FTE 669.73 $ 548.39 $ 36.43 $ 14.45 $ 70.47 $ - $

Bed overheads 85.36 $ 85.36 $ - $ - $ - $ - $

65+ 3,231,795 347 77,932 5,950 4,907 -

Summary 3,231,395 - 77,913 5,943 4,879 -

Selected jurisdiction population 3,119,026 - - - - -

Treatment popn + SBI + Standalone popn 112,369 - 77,913 5,943 4,879 -

Resources for selected population 363 315 17 6 25 -

Clinical Staff FTE 278 230 17 6 25 -

Beds 86 86 - - - -

Cost for selected popn $mill 37.27 $ 31.20 $ 1.87 $ 0.71 $ 3.48 $ - $

Clinical Staff FTE 34.46 $ 28.38 $ 1.87 $ 0.71 $ 3.48 $ - $

Bed overheads 2.82 $ 2.82 $ - $ - $ - $ - $

Total clinical FTE resources - all ages 7,066.01 5,905.66 384.15 153.13 623.07 -

Element % share of total 100% 84% 5% 2% 9% 0%

Total cost - all ages $Mill 805.20 $ 674.93 $ 38.88 $ 15.50 $ 75.89 $ - $

Element % share of total 100% 83.8% 4.8% 1.9% 9.4% 0.0%

Notes 1. Diagnostic Testing and Prescription Medicine cannot be shown as 'resources' at this level as they contain incommensurate unit doses that cannot be counted meaningfully. 2. Staff FTE resources (total staff) and Bed resources (total beds) cannot be summed as they contain incommensurate data types 2. Mod amb is moderate ambulatory 3. Mild amb is mild ambulatory 4. Treatment population sum total persons does not include Harm Reduction, SBI or Stand-Alone items, e.g. CL-ED, CL-Obstets 5. SBI refers to At risk - Brief Intervention 6. Projections apply to population only and proportional costs. No inflation adjustment. Only years 2011-2026, 2031 are viewable.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

7. Clinical staff annual hours can be calculated by multiplying the FTE numbers by 1171 for AMS, NAH and AOD. Or by 1374 for GPs.

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013 DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 5 - Beds, staff numbers and cost by bed type, for single drug Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Year 2011

Sum of TOTAL Column Labels

Resources for selected population Cost for selected popn $mill

Row Labels Clinical Staff FTE Beds Clinical Staff FTE Bed overheads

12-17 Detoxification DT 6.4 3.8 0.78 $ 0.25 $

DT-caretaker 1.0 0.11 $

Residential Rehabilitation RR1 28.5 27.4 2.61 $ 0.37 $

RR2 1.8 0.15 $

RR-caretaker 2.1 0.17 $

18-64 Detoxification DT 181.1 539.4 25.47 $ 36.03 $

DT-caretaker 139.7 15.73 $

Inpatient IN 251.2 114.8 32.13 $ 7.64 $

Residential Rehabilitation RR1 1,539.9 3,087.2 140.53 $ 41.69 $

RR2 261.7 21.56 $

RR-caretaker 243.4 20.05 $

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

RR-caretaker 243.4 20.05 $

65+ Detoxification DT 8.0 23.9 1.16 $ 1.60 $

DT-caretaker 6.2 0.70 $

Inpatient IN 15.9 7.3 2.04 $ 0.48 $

Residential Rehabilitation RR1 26.4 54.5 2.39 $ 0.74 $

RR2 4.0 0.33 $

RR-caretaker 4.4 0.37 $

Grand Total 2,722 3,858 266 89

Summary FTEs Beds FTE $mill Bed Ohead $mill

Detoxification 342 567.06 43.95 $ 37.88 $

Residential Rehabilitation 2,112 3,169.03 188.16 $ 42.80 $

Inpatient 267 122.11 34.17 $ 8.13 $

Notes 1. FTE equals Full Time Equivalent. Resources refers to a count of FTEs (annual requirement) 2. Beds numbers are sum of number of people in bed-based packages multiplied by ALOS and annual occupancy

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

3. GP refers to General Practitioner, AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers, AOD refers to Alcohol and Other Drug workers 4. Small numbers may display as '0.00'. Zero will display as dash '-' for resources. 5. Clinical staff total annual hours can be calculated by multiplying the FTE numbers by 1,171 (1,374 for GPs).

©NSW Ministry of Health 2013.

Report 5b - Bed numbers estimate by bed type

Year 2011

Sum of TOTAL Column Labels

Resources per 100k population Beds

Row Labels Alcohol Amphetamine Benzodiazepine Cannabis Opioids

12-17 Detoxification DT 0.22 0.13 0.14 0.22

Inpatient IN 0.01

Residential Rehabilitation RR1 1.59 1.21 1.29 1.69

18-64 Detoxification DT 3.82 0.50 0.65 0.90

Inpatient IN 0.81 0.06 0.26 0.07 0.16

Residential Rehabilitation RR1 21.87 4.75 5.73 5.25

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

RR1 21.87 4.75 5.73 5.25

RR3 1.31

65+ Detoxification DT 0.77 0.01 0.01 0.11

Inpatient IN 0.23

Residential Rehabilitation RR1 1.75 0.00 0.04 0.19

Grand Total 31.07 6.67 0.26 7.95 9.82

Summary Detoxification 4.81 0.64 - 0.81 1.22

Residential Rehabilitation 25.21 5.96 - 7.06 8.44

Inpatient 1.05 0.06 0.26 0.08 0.16

Summary of bed total estimated requirements by years and bed type

Drug Alcohol

Age (All)

Sum of TOTAL Column Labels

Resources for selected population Grand Total

Beds

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Row Labels Detoxification Inpatient

Residential Rehabilitation

2011 567 122 3,169 3,858

2012 574 124 3,205 3,902

2013 581 125 3,243 3,949

2014 588 127 3,280 3,995

2015 595 128 3,317 4,040

2016 602 130 3,352 4,084

2021 635 137 3,522 4,294

2031 697 152 3,847 4,696

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013 DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 6a - Staff numbers by setting/type and cost, selected years Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug (All)

Age (All)

Sum of TOTAL Column Labels

Row Labels 2011 2016 2021 2026 2031

Clinical Staff FTE Resources for selected population 13,081.0 13,852.7 14,582.1 15,276.3 15,986.5

Ambulatory NAH 5,596 5,937 6,257 6,563 6,877

AOD 1,632 1,727 1,818 1,904 1,992

AMS 508 541 572 602 632

GP 439 467 492 516 541

Detoxification NAH 484 512 540 565 592

AMS 43 45 48 50 52

Inpatient NAH 403 428 450 472 494

AMS 35 37 39 40 42

Residential Rehabilitation NAH 19 19 20 21 22

AOD 3,791 4,002 4,202 4,390 4,583

AMS 0 0 0 0 0

GP 131 139 146 152 159

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

GP 131 139 146 152 159

Cost for selected popn $mill 1,515.69 $ 1,606.23 $ 1,691.65 $ 1,773.06 $ 1,856.30 $

Ambulatory NAH 630.13 $ 668.43 $ 704.47 $ 738.98 $ 774.29 $

AOD 134.44 $ 142.29 $ 149.78 $ 156.90 $ 164.15 $

AMS 156.12 $ 166.19 $ 175.66 $ 184.78 $ 194.04 $

GP 120.85 $ 128.33 $ 135.26 $ 141.88 $ 148.66 $

Detoxification NAH 54.51 $ 57.68 $ 60.75 $ 63.67 $ 66.63 $

AMS 13.09 $ 13.87 $ 14.61 $ 15.32 $ 16.04 $

Inpatient NAH 45.39 $ 48.16 $ 50.72 $ 53.15 $ 55.66 $

AMS 10.60 $ 11.24 $ 11.84 $ 12.41 $ 12.99 $

Residential Rehabilitation NAH 2.09 $ 2.13 $ 2.25 $ 2.38 $ 2.48 $

AOD 312.37 $ 329.77 $ 346.25 $ 361.76 $ 377.68 $

AMS 0.03 $ 0.03 $ 0.03 $ 0.03 $ 0.03 $

GP 36.09 $ 38.12 $ 40.02 $ 41.80 $ 43.64 $

Notes 1. FTE equals Full Time Equivalent. Resources refers to a count of FTEs (annual requirement) 2. GP refers to General Practitioner AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

AOD refers to Alcohol and Other Drug workers 3. Time series cost projections are based on population growth. Inflation is not factored. 4. Clinical staff annual hours can be calculated by multiplying the FTE numbers by 1171 (1374 for GPs). 5. Excludes staff for Harm Reduction. Includes staff for standalone items.

©NSW Ministry of Health 2013.

Report 6b - Staff numbers by type, per 100k and per popn selection Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Age 18-64

Sum of TOTAL Column Labels

Row Labels 2011 2016 2021 2026 2031

Resources per 100k population 42.17 42.13 42.08 42.03 41.99

Clinical Staff FTE NAH 19.22 19.18 19.13 19.08 19.04

AOD 19.72 19.72 19.72 19.72 19.72

AMS 2.13 2.13 2.13 2.13 2.13

GP 1.10 1.10 1.10 1.10 1.10

Resources for selected population 5,952 6,278 6,572 6,844 7,131

Clinical Staff FTE NAH 2,713 2,858 2,987 3,107 3,234

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

NAH 2,713 2,858 2,987 3,107 3,234

AOD 2,783 2,939 3,080 3,212 3,349

AMS 300 317 332 346 361

GP 155 164 172 179 187

Notes 1. FTE equals Full Time Equivalent. Resources refers to a count of FTEs (annual requirement) 2. GP refers to General Practitioner AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers AOD refers to Alcohol and Other Drug workers 3. Time series cost projections are based on population growth. Inflation is not factored. 4. Clinical staff annual hours can be calculated by multiplying the FTE numbers by 1171 (1374 for GPs). 5. Resource estimate excludes staff for Harm Reduction; includes staff for Screening, brief intervention and standalone items.

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 7 - Staff numbers/costs by type working in CL / standalone packages Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Age 18-64

Year 2011

Column Labels

Row Labels NAH AOD AMS GP Grand Total

Clinical Staff FTE Resources for selected population Sum of sev_sal amb info_ed 0.55 - - - 0.55

Sum of sev_sal amb cl_ed stnd 13.98 - - - 13.98

Sum of sev_sal amb cl_ed cmplx 17.96 - - - 17.96

Sum of sev_sal bb_non_spcl_d&a cl gen_co_morbid 74.92 - 9.36 - 84.28

Sum of sev_sal bb_non_spcl_d&a cl gen_int 2.10 - - - 2.10

Sum of sev_sal bb_non_spcl_d&a cl gen_ls 0.80 - 0.06 - 0.87

Sum of sev_sal bb_non_spcl_d&a cl gen_withdr 11.06 - 1.30 - 12.37

Sum of sev_sal bb_non_spcl_d&a cl mh_co_morbid 16.53 - - - 16.53

Sum of sev_sal bb_non_spcl_d&a cl mh_int 1.46 - - - 1.46

Sum of sev_sal bb_non_spcl_d&a cl mh_ls 0.53 - - - 0.53

Sum of sev_sal bb_non_spcl_d&a cl mh_withdr 3.97 - - - 3.97

Sum of sev_sal bb_non_spcl_d&a cl obs 0.92 - - - 0.92

Sum of sev_sal bb_non_spcl_d&a cl racf 0.09 - - - 0.09

Cost for selected popn $mill Sum of sev_sal amb info_ed 0.06 $ - $ - $ - $ 0.06 $

Sum of sev_sal amb cl_ed stnd 1.57 $ - $ - $ - $ 1.57 $

Sum of sev_sal amb cl_ed cmplx 2.02 $ - $ - $ - $ 2.02 $

Sum of sev_sal bb_non_spcl_d&a cl gen_co_morbid 8.44 $ - $ 2.88 $ - $ 11.31 $

Sum of sev_sal bb_non_spcl_d&a cl gen_int 0.24 $ - $ - $ - $ 0.24 $

Sum of sev_sal bb_non_spcl_d&a cl gen_ls 0.09 $ - $ 0.02 $ - $ 0.11 $

Sum of sev_sal bb_non_spcl_d&a cl gen_withdr 1.25 $ - $ 0.40 $ - $ 1.65 $

Sum of sev_sal bb_non_spcl_d&a cl mh_co_morbid 1.86 $ - $ - $ - $ 1.86 $

Sum of sev_sal bb_non_spcl_d&a cl mh_int 0.16 $ - $ - $ - $ 0.16 $

Sum of sev_sal bb_non_spcl_d&a cl mh_ls 0.06 $ - $ - $ - $ 0.06 $

Sum of sev_sal bb_non_spcl_d&a cl mh_withdr 0.45 $ - $ - $ - $ 0.45 $

Sum of sev_sal bb_non_spcl_d&a cl obs 0.10 $ - $ - $ - $ 0.10 $

Sum of sev_sal bb_non_spcl_d&a cl racf 0.01 $ - $ - $ - $ 0.01 $

Total resources (FTEs) 144.88 - 10.73 - 155.61

Total cost 16.31 $ - $ 3.29 $ - $ 19.61 $

Notes 1. FTE equals Full Time Equivalent. Resources refers to a count of FTEs (annual requirement) 2. GP refers to General Practitioner AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers AOD refers to Alcohol and Other Drug workers AM refers to Ambulatory CL refers to consultation and liaison 3. Small numbers may display as '0.00'. Zero will display as dash '-' 4. Standalone care package codes and descriptions are found at tab 'CP codes'

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 8 - Count and costs for diagnostic tests and prescription medicine Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Age 18-64

Year 2011

Values

Row Labels Sum of TOTAL Sum of SEVERE

Sum of mild amb Sum of mod amb

Resources for selected population 88,729,380 51,188,832 - 37,540,548

Diagnostic Testing resource 223,763 223,763 - -

Test Urinary Drug Screen 61,861 61,861 - -

Urea, Electrolytes, Creatine 53,968 53,968 - -

Full Blood Examination 53,968 53,968 - -

Liver Function Tests 53,968 53,968 - -

Prescription Medicine resource 88,505,617 50,965,068 - 37,540,548

Dose Thiamine for relapse prevention

37,703,833 19,698,182 - 18,005,651

Naltrexone 22,312,405 11,657,006 - 10,655,399

Acamprosate calcium 11,156,203 5,828,503 - 5,327,699

Disulfiram 7,437,468 3,885,669 - 3,551,800

Thiamine for withdrawal meds 4,745,599 4,745,599 - -

Tobacco Interventions: 21mg patch 3,551,800 3,551,800 - -

Tobacco Interventions: Buproprion 907,682 907,682 - -

Diazepam - 5mg counted as per dose 641,297 641,297 - -

Tobacco Interventions: Varencline 49,331 49,331 - -

Cost for selected popn $mill 157.07 $ 89.81 $ - $ 67.27 $

Diagnostic Testing 4.34 $ 4.34 $ - $ - $

Test Urinary Drug Screen 1.50 $ 1.50 $ - $ - $

Urea, Electrolytes, Creatine 0.96 $ 0.96 $ - $ - $

Liver Function Tests 0.96 $ 0.96 $ - $ - $

Full Blood Examination 0.92 $ 0.92 $ - $ - $

Prescription Medicine 152.73 $ 85.46 $ - $ 67.27 $

Dose Naltrexone 100.85 $ 52.69 $ - $ 48.16 $

Acamprosate calcium 20.75 $ 10.84 $ - $ 9.91 $

Disulfiram 14.73 $ 7.69 $ - $ 7.03 $

Tobacco Interventions: 21mg patch 8.74 $ 8.74 $ - $ - $

Thiamine for relapse prevention 5 2 - 2

Tobacco Interventions: Buproprion 2 2 - -

Thiamine for withdrawal meds 0.76 $ 0.76 $ - $ - $

Diazepam - 5mg counted as per dose 0.51 $ 0.51 $ - $ - $

Tobacco Interventions: Varencline 0 0 - -

Notes 1. "Resources" refers to total number of doses or tablets for all persons per year 2. Prescription medicine sum of resources is not shown as it contains incommensurate medicine types and doses 3. Diagnostic Testing is shown with slightly different labelling for quantities and for costs 4. Prescription Medicine is shown with slightly different labelling for quantities (resources) and for costs 5. Small numbers may display as '0.00'. Zero will display as dash '-'

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 9 - Output selection for all care packages, by cost Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Alcohol

Age 18-64

Year 2011

Estimate Type Prescription Medicine

Level 1 Cost for selected popn $mill

Share of total cost >>> 0.50% 0.33% 13.59% 66.03% 2.96% 9.64% 5.72% 0.07% 1.16%

Column Labels

Values

Thiamine for withdrawal meds

Diazepam - 5mg counted as per dose Acamprosate

calcium Naltrexone

Thiamine for relapse prevention Disulfiram

Tobacco

Interventions: 21mg patch

Tobacco Interventions: Varencline

Tobacco Interventions: Buproprion

Sum of TOTAL 0.76 0.51 20.75 100.85 4.52 14.73 8.74 0.10 1.77

Sum of SEVERE 0.76 0.51 10.84 52.69 2.36 7.69 8.74 0.10 1.77

Sum of At Risk - Screen, Brief Interv. - - - - - - - - -

Sum of mild amb - - - - - - - - -

Sum of mod amb - - 10 48 2 7 - - -

Sum of mild-mod amb - - - - - - - - -

Sum of sev_12m amb psi stnd - - - - - - 1.05 0.01 0.21

Sum of sev_12m amb psi w_med_stnd - - 2 12 1 2 1 0 0

Sum of sev_12m amb psi cmplx - - - - - - 0.48 0.01 0.10

Sum of sev_12m amb psi w_med_cmplx - - 1 5 0 1 0 0 0

Sum of sev_12m amb otp stnd - - - - - - - - -

Sum of sev_12m amb otp cmplx - - - - - - - - -

Sum of sev_12m amb rehab nrr_dp 0.01 0.01 - - - - 0.09 0.00 0.02

Sum of sev_12m amb wdm hb_stnd 0.06 0.04 - - - - 0.42 0.00 0.08

Sum of sev_12m amb wdm op_stnd 0.16 0.11 - - - - 1.22 0.01 0.25

Sum of sev_12m amb wdm op_w_med_stnd 0 0 1 5 0 1 0 0 0

Sum of sev_12m amb wdm op_w_med_cmplx 0 0 2 10 0 1 1 0 0

Sum of sev_12m amb wdm c_out - - - - - - - - -

Sum of sev_12m amb wdm c_out_pc - - - - - - - - -

Sum of sev_12m amb wdm op_cmplx - - - - - - - - -

Sum of sev_12m bb_res wdm w_med_stnd 0 0 2 11 1 2 1 0 0

Sum of sev_12m bb_res wdm w_med_cmplx 0 0 1 5 0 1 0 0 0

Sum of sev_12m bb_res wdm stnd - - - - - - - - -

Sum of sev_12m bb_res wdm cmplx - - - - - - - - -

Sum of sev_12m bb_res rehab rr_8 0.03 0.02 - - - - 0.22 0.00 0.04

Sum of sev_12m bb_res rehab rr_13 0.04 0.02 - - - - 0.26 0.00 0.05

Sum of sev_12m bb_res rehab rr_26 0.03 0.02 - - - - 0.22 0.00 0.04

Sum of sev_12m bb_res rehab rr_18 - - - - - - - - -

Sum of sev_12m bb_res rehab rr_26_mtar - - - - - - - - -

Sum of sev_12m bb_res rehab rr_26_rtod - - - - - - - - -

Sum of sev_12m bb_res rehab rr_mtar - - - - - - - - -

Sum of sev_12m bb_spcl_Paed NAS - - - - - - - - -

Sum of sev_12m bb_spcl_d&a wdm da_bed 0.07 0.04 1.11 5.39 0.24 0.79 0.49 0.01 0.10

Sum of sev_12m bb_spcl_d&a wdm c_inpt - - - - - - - - -

Sum of sev_12m bb_spcl_d&a wdm c_inpt_pc - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl ccei_1to11mnths - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl ccei_1to11yrs - - - - - - - - -

Sum of sev_sal amb info_ed - - - - - - - - -

Sum of sev_sal amb cl_ed stnd - - - - - - - - -

Sum of sev_sal amb cl_ed cmplx - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl gen_co_morbid - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl gen_int - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl gen_ls - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl gen_withdr - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl mh_co_morbid - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl mh_int - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl mh_ls - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl mh_withdr - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl obs - - - - - - - - -

Sum of sev_sal bb_non_spcl_d&a cl racf - - - - - - - - -

Notes 1. Small numbers may display as '0.00'. Zero will display as dash '-' 2. Care package codes and descriptions are found at tab 'CP codes'

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 10 - Occasions Of Service (OOS) - one care package (2012) Data on service for a single person for one year - derived from 'Data' worksheet, not 'Database' with multiple years Prevalence rates and population data are not relevan t to this table

Drug Opioids

A ge 18-64

OOS

Sum of sev_12m amb otp stnd

Estimate Type Activity Name

Activity Staff Activity Duration Total

Time in mins or tests/doses

Diagnostic Testing Urinary Drug Screen #N/A 1 7 7

Urea, Electrolytes, Creatine #N/A 1 2 2

Full Blood Examination #N/A 1 2 2

Liver Function Tests #N/A 1 2 2

Prescription Medicine Methadone for OST program (dose age 18+) #N/A 1 183 183

Buprenorphine-naloxone for OST program - 8mg (age 18+) #N/A 1 146 146

Buprenorphine for OST program - 8mg (age 18+) #N/A 1 37 37

Tobacco Interventions: 21mg patch #N/A 1 36 36

Tobacco Interventions: Buproprion #N/A 1 9 9

Dosing methadone or buprenorphine or buprenorphine naloxone #N/A 1 1 1

Tobacco Interventions: Varencline #N/A 1 1 1

Clinical Staff FTE Case management (Maintenance) NAH 30 12 360

Medical reviews by doctor -GP for OST program GP 30 11 341

UDS / UDS per year NAH 20 7 140

1:1 psychosocial intervention/family/supporter NAH 60 6 360

Liaison with prescriber NAH 10 6 60

Medical reviews by doctor -AMS for OST program AMS 30 5 139

Case conference AOD 40 -

NAH 15 1 15

30 3 90

Case management (week 2 to 4) / Case Management NAH 30 3 90

Staff time to review Varencline or Buproprion or NRT patches for OST program AMS 1 1 1

GP 2 1 2

Transfer of care/ discharge / care coordination AOD 30 -

NAH 30 2 60

Referral (pharmacy, clinical psychology, counselling) NAH 15 2 30

Induction dosing reviews by pharmacist NAH 5 2 10

Staff time to deliver the tobacco intervention/person AOD 24 1 24

Intake NAH 15 1 15

Diagnostic testing (incl routine bloods, FBC, U & E, LFT) NAH 30 1 30

Assessment by doctor -GP for OST program GP 43 1 43

Assessment AOD 60 -

NAH 30 -

40 -

50 -

60 1 60

75 -

Bloods per year NAH 30 1 30

Assessment by case manager NAH 60 1 60

Assertive follow up - phone call AOD 10 1 10

Assessment by doctor -AMS for OST program AMS 17 1 17

Pharmacy initiation by pharmacist NAH 30 1 30

Referral NAH 30 1 30

Notes 1. Occasions of service refers to single person activities per care package. There is no population for this table 2. Data is implicitly 2012, as this is the main year of activity analysis. 3. Activity duration refers to minutes for clinical staff and to unit tests/doses for diagnostics and prescription medicines 4. A maximum of 1 page is displayed

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 11 - Care packages - activities sorted by cost Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Note: sort order for this Pivot is based on 'otp standard'. For other options, Right click in cell B14/Sort/More sort options

Drug Opioids

Age 18-64

Year 2011

342.04 $

164.93 $ mill Total

Level 1 Values

Cost for selected popn $mill

Activity Name Estimate Type Activity Staff

Sum of sev_12m amb otp stnd

Sum of sev_12m amb otp cmplx Total

% share of total cost

Dosing methadone or buprenorphine or buprenorphine naloxonePrescription Medicine N/A 74.20 $ 31.80 $ 106.00 $ 21%

Buprenorphine-naloxone for OST program - 8mg (age 18+)

Prescription Medicine N/A 56.31 $ 24.13 $ 80.44 $ 16%

Medical reviews by doctor -GP for OST program

Clinical Staff FTE GP 46.35 $ 19.86 $ 66.21 $ 13%

Medical reviews by doctor -AMS for OST program

Clinical Staff FTE AMS 24.80 $ 10.63 $ 35.43 $ 7%

Case management (Maintenance)

Clinical Staff FTE NAH 23.52 $ 10.08 $ 33.60 $ 7%

1:1 psychosocial intervention/family/supporter

Clinical Staff FTE NAH 23.52 $ 20.16 $ 43.68 $ 9%

Buprenorphine for OST program - 8mg (age 18+)

Prescription Medicine N/A 12.97 $ 5.56 $ 18.53 $ 4%

UDS / UDS per year Clinical Staff FTE NAH

9.15 $ 3.92 $ 13.07 $ 3%

Urinary Drug Screen Diagnostic Testing N/A

6.92 $ 2.97 $ 9.89 $ 2%

Case conference Clinical Staff FTE NAH

6.86 $ 3.36 $ 10.22 $ 2%

AOD

- $ - $ - $ 0%

Case management (week 2 to 4) / Case Management

Clinical Staff FTE NAH 5.88 $ 2.52 $ 8.40 $ 2%

Assessment by doctor -GP for OST program

Clinical Staff FTE GP 5.85 $ 2.51 $ 8.35 $ 2%

Methadone for OST program (dose age 18+)

Prescription Medicine N/A 4.92 $ 2.11 $ 7.03 $ 1%

Assessment by case manager

Clinical Staff FTE NAH 3.92 $ 1.68 $ 5.60 $ 1%

Transfer of care/ discharge / care coordination

Clinical Staff FTE NAH 3.92 $ 3.36 $ 7.28 $ 1%

AOD

- $ - $ - $ 0%

Assessment Clinical Staff FTE NAH

3.92 $ 3.36 $ 7.28 $ 1%

AOD

- $ - $ - $ 0%

Liaison with prescriber Clinical Staff FTE NAH

3.92 $ 3.36 $ 7.28 $ 1%

Tobacco Interventions: 21mg patch

Prescription Medicine N/A 3.61 $ 1.55 $ 5.16 $ 1%

Assessment by doctor -AMS for OST program

Clinical Staff FTE AMS 3.03 $ 1.30 $ 4.33 $ 1%

Referral Clinical Staff FTE NAH

1.96 $ 0.84 $ 2.80 $ 1%

Pharmacy initiation by pharmacist

Clinical Staff FTE NAH 1.96 $ 0.84 $ 2.80 $ 1%

Diagnostic testing (incl routine bloods, FBC, U & E, LFT)

Clinical Staff FTE NAH 1.96 $ 0.84 $ 2.80 $ 1%

Bloods per year Clinical Staff FTE NAH

1.96 $ 0.84 $ 2.80 $ 1%

Referral (pharmacy, clinical psychology, counselling)

Clinical Staff FTE NAH 1.96 $ 0.84 $ 2.80 $ 1%

Urea, Electrolytes, Creatine

Diagnostic Testing N/A 1.45 $ 0.62 $ 2.07 $ 0%

Liver Function Tests Diagnostic Testing N/A

1.45 $ 0.62 $ 2.07 $ 0%

Full Blood Examination Diagnostic Testing N/A

1.39 $ 0.60 $ 1.99 $ 0%

Staff time to deliver the tobacco intervention/person

Clinical Staff FTE AOD 1.15 $ 0.49 $ 1.64 $ 0%

Intake Clinical Staff FTE NAH

0.98 $ 0.84 $ 1.82 $ 0%

Tobacco Interventions: Buproprion

Prescription Medicine N/A 0.73 $ 0.31 $ 1.04 $ 0%

Induction dosing reviews by pharmacist

Clinical Staff FTE NAH 0.65 $ 0.28 $ 0.93 $ 0%

Assertive follow up - phone call

Clinical Staff FTE AOD 0.48 $ 0.20 $ 0.68 $ 0%

Staff time to review Varencline or Buproprion or NRT patches for OST program Clinical Staff FTE AMS 0.12 $ 0.05 $ 0.18 $ 0%

GP

0.23 $ 0.10 $ 0.33 $ 0%

Tobacco Interventions: Varencline

Prescription Medicine N/A 0.04 $ 0.02 $ 0.06 $ 0%

Pre employment training (assume 1 staff: 1 participant)

Clinical Staff FTE AOD - $ - $ - $ 0%

Admission time which includes orientation, check / search.

Clinical Staff FTE AOD - $ - $ - $ 0%

Referral / transfer of care / follow up

Clinical Staff FTE NAH - $ - $ - $ 0%

AOD

- $ - $ - $ 0%

Clinical care by nursing / allied health staff

Clinical Staff FTE NAH - $ - $ - $ 0%

Buprenorphine for withdrawal management - 8mg

Prescription Medicine N/A - $ - $ - $ 0%

(blank) Bed overheads Bed

- $ - $ - $ 0%

Dosing - cessation or transfer -discharge tasks (40 min)

Clinical Staff FTE AOD - $ - $ - $ 0%

Complex case conference Clinical Staff FTE NAH

- $ - $ - $ 0%

Dosing - cessation or transfer - exiting / completion

Clinical Staff FTE AOD - $ - $ - $ 0%

Overnight and weekend component

Clinical Staff FTE NAH - $ - $ - $ 0%

AOD

- $ - $ - $ 0%

Nurse / consultation liaison

Clinical Staff FTE NAH - $ - $ - $ 0%

Notes 1. Six Care Package columns can be added in total

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

DA-CCP Estimator Tool - Final Version

2. GP refers to General Practitioner, AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers, AOD refers to Alcohol and Other Drug workers

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 12a - OTP care packages - clinical staff FTE resources and costs Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Drug Opioids

Year 2011

Column Labels

Row Labels

Sum of sev_12m amb otp stnd

Sum of sev_12m amb otp cmplx

Sum of sev_12m amb otp stnd

Sum of sev_12m amb otp cmplx

Sum of sev_12m amb otp stnd

Sum of sev_12m amb otp cmplx

% share of subtotal

Resources for selected population Clinical Staff FTE - 6.0 1,154.4 657.6 - 111.7

Ambulatory - 6.0 1,154.4 657.6 - 111.7 100%

NAH - 4.4 853.0 528.4 - 91.8 77%

AOD - 0.4 19.7 8.5 - 1.3 2%

AMS - 0.4 91.0 39.0 - 6.0 7%

GP - 0.8 190.6 81.7 - 12.6 15%

Cost for selected popn $mill Clinical Staff FTE - $ 0.88 $ 178.04 $ 94.64 $ - $ 15.77 $

Ambulatory - $ 0.88 $ 178.04 $ 94.64 $ - $ 15.77 $ 100%

NAH - $ 0.50 $ 96.04 $ 59.50 $ - $ 10.33 $ 58%

AOD - $ 0.03 $ 1.63 $ 0.70 $ - $ 0.11 $ 1%

AMS - $ 0.12 $ 27.95 $ 11.98 $ - $ 1.85 $ 14%

GP - $ 0.23 $ 52.42 $ 22.47 $ - $ 3.48 $ 27%

Resources per 100k population Clinical Staff FTE - 0.4 8.2 4.7 - 3.6

Ambulatory - 0.4 8.2 4.7 - 3.6

NAH - 0.3 6.0 3.7 - 2.9

AOD - 0.0 0.1 0.1 - 0.0

AMS - 0.0 0.6 0.3 - 0.2

GP - 0.0 1.4 0.6 - 0.4

Costs per 100k population $mill Clinical Staff FTE - $ 0.05 $ 1.26 $ 0.67 $ - $ 0.51 $

Ambulatory - $ 0.05 $ 1.26 $ 0.67 $ - $ 0.51 $

NAH - $ 0.03 $ 0.68 $ 0.42 $ - $ 0.33 $

AOD - $ 0.00 $ 0.01 $ 0.00 $ - $ 0.00 $

AMS - $ 0.01 $ 0.20 $ 0.08 $ - $ 0.06 $

GP - $ 0.01 $ 0.37 $ 0.16 $ - $ 0.11 $

Notes 1. Small numbers may display as '0.00'. Zero will display as dash '-' 2. GP refers to General Practitioner, AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers, AOD refers to Alcohol and Other Drug workers

©NSW Ministry of Health 2013.

12-17 18-64 65+

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 12b - Opioid treatment programs - resources and costs

Drug Opioids

Age (All)

Year 2011

Column Labels Staff

Row Labels

(blank) Bed NAH AOD AMS GP total

Summary Treatment population Sum of sev_12m amb otp stnd 40,768 Sum of sev_12m amb otp cmplx 20,271

Sum of sev_12m bb_res rehab rr_26_mtar 166 Sum of sev_12m bb_res rehab rr_26_rtod 166 Resources for selected population Clinical Staff FTE

Sum of sev_12m amb otp stnd 853 20 91 191 1,154

Sum of sev_12m amb otp cmplx 625 10 45 95 775

Sum of sev_12m bb_res rehab rr_26_mtar 3 57 0 2 62

Sum of sev_12m bb_res rehab rr_26_rtod 5 58 0 2 65

Beds -

Sum of sev_12m amb otp stnd - -

Sum of sev_12m amb otp cmplx -

Sum of sev_12m bb_res rehab rr_26_mtar 71

Sum of sev_12m bb_res rehab rr_26_rtod 121

Cost for selected popn $mill Clinical Staff FTE Sum of sev_12m amb otp stnd 96.04 $ 1.63 $ 27.95 $ 52.42 $ 178.04 $

Sum of sev_12m amb otp cmplx 70.33 $ 0.84 $ 13.95 $ 26.17 $ 111.29 $

Sum of sev_12m bb_res rehab rr_26_mtar 0.39 $ 4.70 $ 0.07 $ 0.46 $ 5.62 $

Sum of sev_12m bb_res rehab rr_26_rtod 0.52 $ 4.79 $ 0.07 $ 0.46 $ 5.84 $

Bed overheads Sum of sev_12m amb otp stnd - $

Sum of sev_12m amb otp cmplx - $

Sum of sev_12m bb_res rehab rr_26_mtar 1.15 $ Sum of sev_12m bb_res rehab rr_26_rtod 1.83 $

Summary Total treatment population 61,372

Clinical Staff resources 1,485.7 145.0 136.9 289.1 2,056.8

Bed resources (number) 192.1

Clinical Staff costs $mill 167.28 $ 11.95 $ 42.04 $ 79.51 $ 300.79 $

Bed overhead costs $mill 2.99 $

Notes 1. FTE equals Full Time Equivalent. Resources refers to a count of FTEs (annual requirement) 2. Beds are sum of number of people in bed-based packages multiplied by ALOS and annual occupancy 3. GP refers to General Practitioner AMS refers to Medical Specialist NAH refers to Nurses and Allied Health workers AOD refers to Alcohol and Other Drug workers 4. Small numbers may display as '0.00'. Zero will display as dash '-' for resources. 5. Clinical staff annual hours can be calculated by multiplying the FTE numbers by 1171 (1374 for GPs).

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

DA-CCP Estimator Tool - Final Version

6. Treatment population is total persons requiring treatment including Severe, mild, moderate only

©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 13 - D&A Bed - clinical staff activities sorted by grand total cost Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction

Cost for selected popn $mill Year 2011

Drug Alcohol

Estimate Type Clinical Staff FTE

Level 1 Cost for selected popn $mill

Sum of sev_12m bb_spcl_d&a wdm da_bed Age

Activity Name 12-17 18-64 65+ Grand Total

Clinical care by nursing / allied health staff 26.05 $ 26.05 $

Medical Review with prescribing 6.52 $ 6.52 $

Clinical care by medical staff 6.08 $ 6.08 $

Psychosocial intervention / counselling 1:1 5.31 $ 5.31 $

Assessment or Intake 2.39 $ 2.39 $

Case conference - $ 2.10 $ 0.12 $ 2.22 $

Transfer / referral / co-ordination of care / follow up / discharge 1.86 $ 1.86 $

Inpatient care by nurse 1.65 $ 1.65 $

Medical Assessment or Consultation 1.45 $ 0.11 $ 1.56 $

Case management / case management implementation / support - $ 1.17 $ 0.07 $ 1.23 $

Case management / case management assessment - $ 0.78 $ 0.05 $ 0.83 $

Medical Review and prescribing 0.49 $ 0.49 $

Family / carer engagement - $ 0.39 $ 0.02 $ 0.41 $

Discharge / referral / transfer of care / follow up - $ 0.39 $ 0.02 $ 0.41 $

Group counselling (assume 1 staff and 8 participants) - $ 0.40 $ - $ 0.40 $

Inpatient care by doctor 0.38 $ 0.38 $

Psychosocial intervention 1:1 0.30 $ 0.30 $

Assessment / screening and orientation 0.27 $ 0.27 $

Screening or Assessment or Intake 0.18 $ 0.18 $

Staff time to review and prescribe Varencline or Buproprion or NRT patches 0.17 $ 0.01 $ 0.18 $

Staff time to deliver the tobacco intervention/person - $ 0.16 $ 0.01 $ 0.16 $

Transfer / referral of care / follow up / care coordination 0.14 $ 0.14 $

Bloods / diagnostic testing 0.09 $ 0.01 $ 0.09 $

Assertive follow up - phone call - $ 0.06 $ 0.00 $ 0.07 $

Group sessions - (Assume 1 x staff for 8 participants) - $ 0.02 $ 0.02 $

Family engagement - -

Discharge /referral /transfer of care/follow up (incl. Exit survey, exit pack) - -

Group counselling (assume 1 staff and 10 participants) - - -

Medical Assessment - $ - $

VETE (NOT ON the job) (1 staff and 15 participants) - -

Medical Assessment and prescribing - $ - $ - $

Psychosocial activity (work & recreation) (assume 1 staff & 8 participants) (120 mins) - - -

Medical Assessment or Consultation or clinical intervention (60 min) - $ - $

Induction - -

Medical consultation - $ - $

Incoming telephone calls - -

Medical liaison with another provider - $ - $ - $

D&A Nurse - -

Medical Review - $ - $ - $ - $

Group sessions - (Assume 1 x staff and 5 participants) - - -

Assessment - $ - $ - $ - $

Notes 1. A maximum of 1 page is displayed ©NSW Ministry of Health 2013.

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 14 - Resource estimates - all drugs and ages (heat map) Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction Year 2011 Estimate Type Beds

Level 1 Resources for selected population

Percentage share of total >>> 0.5% 55.6% 1.3% 0.3% 11.2% 0.0% 0.6% 0.4% 13.6% 0.0% 0.5% 16.0% 0.1%

Column Labels

Benzodiazepin Total

Values 12-17 18-64 65+ 12-17 18-64 65+ 18-64 12-17 18-64 65+ 12-17 18-64 65+

Sum of TOTAL 31 3,741 86 23 750 0 37 25 911 2 33 1,075 9 6,723

Sum of At Risk - Screen, Brief Interv. - - - - - - - - - - - - - -

Sum of mild amb - - - - - - - - - - - - - -

Sum of mod amb - - - - - - - - - - - - - -

Sum of mild-mod amb - - - - - - - - - - - - - -

Sum of sev_12m amb psi stnd - - - - - - - - - - - - - -

Sum of sev_12m amb psi w_med_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb psi cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb psi w_med_cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb otp stnd - - - - - - - - - - - - - -

Sum of sev_12m amb otp cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb rehab nrr_dp - - - - - - - - - - - - - -

Sum of sev_12m amb wdm hb_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_w_med_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_w_med_cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb wdm c_out - - - - - - - - - - - - - -

Sum of sev_12m amb wdm c_out_pc - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_cmplx - - - - - - - - - - - - - -

Sum of sev_12m bb_res wdm w_med_stnd 1 254 14 - - - - - - - - - - 270

Sum of sev_12m bb_res wdm w_med_cmplx 1 111 6 1 26 0 - - - - - - - 145

Sum of sev_12m bb_res wdm stnd - - - - - - - 1 38 0 - 46 - 85

Sum of sev_12m bb_res wdm cmplx - - - - - - - - - - 2 20 3 24

Sum of sev_12m bb_res rehab rr_8 - 552 10 - - - - - - - - 186 7 755

Sum of sev_12m bb_res rehab rr_13 - 1,036 25 - 716 0 - - 863 1 - 495 - 3,137

Sum of sev_12m bb_res rehab rr_26 - 1,673 23 - - - - - - - - 113 - 1,809

Sum of sev_12m bb_res rehab rr_18 29 - - 22 - - - 24 - - 31 - - 107

Sum of sev_12m bb_res rehab rr_26_mtar - - - - - - - - - - - 71 - 71

Sum of sev_12m bb_res rehab rr_26_rtod - - - - - - - - - - - 121 - 121

Sum of sev_12m bb_res rehab rr_mtar - - - - - - - - - - - - - -

Sum of sev_12m bb_spcl_Paed NAS - - - - - - - - - - - - - -

Sum of sev_12m bb_spcl_d&a wdm da_bed - 115 7 - 8 - - 0 10 - - 22 - 163

Sum of sev_12m bb_spcl_d&a wdm c_inpt - - - - - - 5 - - - - - - 5

Sum of sev_12m bb_spcl_d&a wdm c_inpt_pc - - - - - - 32 - - - - - - 32

Notes 1. "Resources" refers to total number of beds, FTE persons, doses or tablets for all persons 2. Small numbers may display as '0.00'. Zero will display as dash '-' 3. Care package codes and descriptions are found at tab 'CP codes'

4. Standalone items are not shown in the 'Values' list of pivot table

©NSW Ministry of Health 2013.

Alcohol Amphetamine Cannabis Opioids

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013

Report 15 - Bed separations - all drugs and ages (heat map) Australia is the selected population jurisdiction; Australia is the selected wage jurisdiction Year 2011 Level 2 Separations

Level 1 Resources for selected population

Percentage share of total >>> 0.5% 56.4% 2.2% 0.3% 10.0% 0.0% 2.1% 0.4% 12.6% 0.0% 0.5% 14.8% 0.2%

Column Labels

Benzodiazepin Total

Values 12-17 18-64 65+ 12-17 18-64 65+ 18-64 12-17 18-64 65+ 12-17 18-64 65+

Sum of TOTAL 352 43,312 1,651 241 7,679 24 1,592 271 9,700 24 360 11,398 180 76,787

Sum of At Risk - Screen, Brief Interv. - - - - - - - - - - - - - -

Sum of mild amb - - - - - - - - - - - - - -

Sum of mod amb - - - - - - - - - - - - - -

Sum of mild-mod amb - - - - - - - - - - - - - -

Sum of sev_12m amb psi stnd - - - - - - - - - - - - - -

Sum of sev_12m amb psi w_med_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb psi cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb psi w_med_cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb otp stnd - - - - - - - - - - - - - -

Sum of sev_12m amb otp cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb rehab nrr_dp - - - - - - - - - - - - - -

Sum of sev_12m amb wdm hb_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_w_med_stnd - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_w_med_cmplx - - - - - - - - - - - - - -

Sum of sev_12m amb wdm c_out - - - - - - - - - - - - - -

Sum of sev_12m amb wdm c_out_pc - - - - - - - - - - - - - -

Sum of sev_12m amb wdm op_cmplx - - - - - - - - - - - - - -

Sum of sev_12m bb_res wdm w_med_stnd 40 11,543 644 - - - - - - - - - - 12,228

Sum of sev_12m bb_res wdm w_med_cmplx 40 5,032 293 34 1,159 13 - - - - - - - 6,570

Sum of sev_12m bb_res wdm stnd - - - - - - - 39 1,726 14 - 2,080 - 3,859

Sum of sev_12m bb_res wdm cmplx - - - - - - - - - - 72 915 120 1,107

Sum of sev_12m bb_res rehab rr_8 - 4,933 88 - - - - - - - - 1,664 60 6,745

Sum of sev_12m bb_res rehab rr_13 - 8,879 212 - 6,134 12 - - 7,398 10 - 4,243 - 26,889

Sum of sev_12m bb_res rehab rr_26 - 7,400 102 - - - - - - - - 499 - 8,001

Sum of sev_12m bb_res rehab rr_18 271 - - 207 - - - 220 - - 288 - - 987

Sum of sev_12m bb_res rehab rr_26_mtar - - - - - - - - - - - 499 - 499

Sum of sev_12m bb_res rehab rr_26_rtod - - - - - - - - - - - 499 - 499

Sum of sev_12m bb_res rehab rr_mtar - - - - - - - - - - - - - -

Sum of sev_12m bb_spcl_Paed NAS - - - - - - - - - - - - - -

Sum of sev_12m bb_spcl_d&a wdm da_bed - 5,525 312 - 386 - - 13 575 - - 998 - 7,810

Sum of sev_12m bb_spcl_d&a wdm c_inpt - - - - - - 212 - - - - - - 212

Sum of sev_12m bb_spcl_d&a wdm c_inpt_pc - - - - - - 1,380 - - - - - - 1,380

Notes 1. "Resources" (if selected) refers to total number of beds, FTE persons, doses or tablets for all persons 2. Small numbers may display as '0.00'. Zero will display as dash '-' 3. Care package codes and descriptions are found at tab 'CP codes'

4. Standalone items are not shown in the 'Values' list of pivot table

©NSW Ministry of Health 2013.

Alcohol Amphetamine Cannabis Opioids

DA-CCP National Reporting Model 2.4.1 Mar2013.xlsm 02/04/2013