Sean M. Murphy, PhD (Washington State University, PN Node), Aimee N. C. Campbell, PhD, MSW (New York State Psychiatric Institute, GNY Node), Udi E. Ghitza, PhD (NIDA Center for the Clinical Trials Network), Tiffany L. Kyle, PhD (Aspire Health Partners, FNA Node), Genie L. Bailey, MD (Stanley Street Treatment and Resources, Inc., NEC Node), Edward V. Nunes, MD (New York State Psychiatric Institute, Columbia University, GNY Node), Daniel Polsky, PhD (University of Pennsylvania School of Medicine, DV Node).
Drug and Alcohol Dependence 2016;161(1):119-126. [doi: 10.1016/j.drugalcdep.2016.01.021]
Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an Internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES) (CTN protocol 0044, "Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders"). The study involved an economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry).
Results found that, from the provider's perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU participants remained in treatment longer and achieved more days of abstinence than TAU patients. Regarding clinical outcome of abstinent years, TES+TAU qualifies as cost-effective with a level of confidence exceeding 95% for willingness-to-pay values above $20,000. That is, if the stakeholder is willing to pay $20,000 per abstinent-year, it is 95% likely they will find TES+TAU to be a "good value." In general, findings were more promising for participants who were not abstinent at study entry.
Conclusions: With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. Moreover, depending on providers' and payers' thresholds for defining value with regard to abstinence, TES+TAU has a high likelihood of being considered a wise investment. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy. (Article, Peer-Reviewed, PDF, English, 2016)
Keywords: Behavior therapy | Community Reinforcement Approach (CRA) | Contingency Management (CM) | Cost-effectiveness | CTN platform/ancillary study | Internet counseling | Motivational incentives | Therapeutic Education System (TES) | Drug and Alcohol Dependence (journal)
Document No: 1186, PMID: 26880594, PMCID: PMC4792755 (available 4/1/2017).
Submitted by CTN Dissemination Librarians, 2/8/2016.