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 - Funding Information:
Supported by grants from the National Drug Abuse Treatment Clinical Trials Network, National Institute on Drug Abuse (NIDA) : U10 DA013035 (to Edward V. Nunes and John Rotrosen), U10 DA015831 (to Kathleen M. Carroll and Roger D. Weiss), U10 DA013034 (to Maxine Stitzer and Robert P. Schwartz), U10 DA013720 (to José Szapocznik and Lisa R. Metsch), U10 DA013732 (to Theresa Winhusen), U10 DA020024 (to Madhukar H. Trivedi), U10 DA013714 (to Dennis M. Donovan and John Roll), U10 DA015815 (to James L. Sorensen and Dennis McCarty), and K24 DA022412 (to Edward V. Nunes).
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
VL - 161
SP - 119
EP - 126
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -