estimates, when available. All unit costs were adjusted to the 2008 Consumer Price Index by using urban consumer yearly averages from the Bureau of Labor Statistics. Although we strove to derive methodologically comparable unit costs, we had to rely upon multiple sources, which is a common study limitation (39). Following Steadman et al. (17), estimated costs per unit for behavioral health services were chiefly based on the Medical Expenditure Panel Survey event files (MEPS.ahrq.gov), supplemented by cost estimates for nonmedical support services from the Clinical Antipsychotic Trials of Intervention Effectiveness (23). Estimated unit costs for criminal justice contacts were based on three sources. The estimated cost of an arrest was based on Clark et al.’s (24) study of people with co-occurring mental and substance abuse disorders. The estimated cost of a day in jail and in prison were based on McCollister et al.’s (25) study of people with substance abuse disorders, supplemented by national estimates by Perkins et al. (26) and the Pew Center (27). The estimated cost per day of traditional probation supervision is based on the national estimate by the Pew Center (27); specialty mental health supervision is estimated to cost 1.97 times more, given Texas legislative data (28) and Pew’s (27) relative estimates for regular vs. intensive supervision. Analyses Because participants were not randomly assigned to probation type, it would be misleading to statistically compare raw, average cost estimates for traditional and specialty groups. To rigorously control for potential confounders, we used Targeted Maximum Likelihood Estimation (TMLE), in tandem with a data adaptive algorithm called SuperLearner, to estimate the average difference in cost between groups. TMLE is a double-robust, semi-parametric estimator that uses estimates of both the (i.e., propensity score; or probability of specialty probation assignment, treatment mechanism
estimates, when available. All unit costs were adjusted to the 2008 Consumer Price Index by using urban consumer yearly averages from the Bureau of Labor Statistics. Although we strove to derive methodologically comparable unit costs, we had to rely upon multiple sources, which is a common study limitation (39). Following Steadman et al. (17), estimated costs per unit for behavioral health services were chiefly based on the Medical Expenditure Panel Survey event files (MEPS.ahrq.gov), supplemented by cost estimates for nonmedical support services from the Clinical Antipsychotic Trials of Intervention Effectiveness (23). Estimated unit costs for criminal justice contacts were based on three sources. The estimated cost of an arrest was based on Clark et al.’s (24) study of people with co-occurring mental and substance abuse disorders. The estimated cost of a day in jail and in prison were based on McCollister et al.’s (25) study of people with substance abuse disorders, supplemented by national estimates by Perkins et al. (26) and the Pew Center (27). The estimated cost per day of traditional probation supervision is based on the national estimate by the Pew Center (27); specialty mental health supervision is estimated to cost 1.97 times more, given Texas legislative data (28) and Pew’s (27) relative estimates for regular vs. intensive supervision. Analyses Because participants were not randomly assigned to probation type, it would be misleading to statistically compare raw, average cost estimates for traditional and specialty groups. To rigorously control for potential confounders, we used Targeted Maximum Likelihood Estimation (TMLE), in tandem with a data adaptive algorithm called SuperLearner, to estimate the average difference in cost between groups. TMLE is a double-robust, semi-parametric estimator that uses estimates of both the treatment mechanism (i.e., propensity score; or probability of specialty probation assignment,
comparing_costs_of_traditional_versus_specialty_probation.docx