TY - JOUR
T1 - Cost-effectiveness of an internet-delivered treatment for substance abuse
T2 - Data from a multisite randomized controlled trial
AU - Murphy, Sean M.
AU - Campbell, Aimee N.C.
AU - Ghitza, Udi E.
AU - Kyle, Tiffany L.
AU - Bailey, Genie L.
AU - Nunes, Edward V.
AU - Polsky, Daniel
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: 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). Methods: 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: 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 has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. 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. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy.
AB - Background: 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). Methods: 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: 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 has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. 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. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy.
KW - Community reinforcement approach
KW - Contingency management
KW - Cost effectiveness
KW - Internet-based intervention
KW - Substance use disorders
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U2 - 10.1016/j.drugalcdep.2016.01.021
DO - 10.1016/j.drugalcdep.2016.01.021
M3 - Article
C2 - 26880594
AN - SCOPUS:84957627686
SN - 0376-8716
VL - 161
SP - 119
EP - 126
JO - Drug and alcohol dependence
JF - Drug and alcohol dependence
ER -