Jody L. Sindelar, PhD (Yale University School of Medicine, NE Node), Todd A. Olmstead, PhD (Yale University School of Medicine, NE Node), Jessica M. Peirce, PhD (Johns Hopkins University School of Medicine, MA Node).

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This paper reports on a cost-effectiveness study of protocol CTN-0007, designed to determine if prize-based contingency management (CM), which has been shown to improve treatment outcomes over usual care (UC) alone, is worth the additional cost to treatment agencies. Six methadone maintenance community-based treatment programs (CTPs) in the CTN participated, with a study sample of 388 participants, 190 in the UC condition and 198 in the CM condition (which combined usual care with contingency management).

The authors found that prize-based contingency management provided better patient outcomes than usual care, but required additional costs. Compared to usual care, the incremental cost of using prize-based contingency management to lengthen the longest duration of abstinence (LDA) by one week was $141. The incremental cost to obtain an additional stimulant-negative urine sample was $70. Whether this extra expenditure is worthwhile depends upon the value placed on these outcomes. Using only the benefit of averted crime, an acceptability curve developed by the authors demonstrates a cost-effectiveness benefit of 90%. However, this estimate is quite conservative because averted crime is only one of the many potential benefits of a reduction in substance abuse. By comparing this study to a companion study, the authors also found that adding prize-based contingency management to usual care may be more cost-effective in methadone maintenance clinics than in counseling-based drug-free clinics. Further empirical analyses are needed to help policy makers decide whether CM is worth the extra expense; this paper helps to build an empirical basis for these important decisions. (Article (Peer-Reviewed), PDF, English, 2007)

Keywords: Adoption of interventions | Behavior therapy | Community health services | Contingency management (CM) | Cost-effectiveness | CTN outcomes | Methadone maintenance | Methamphetamine | MIEDAR | Motivational incentives | Stimulant abuse | Addiction (journal)

Document No: 227

Submitted by CTN Dissemination Librarians, 9/21/2007.