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. Find it in the CTN Dissemination Library: http://ctndisseminationlibrary.org/display/1186.htm
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Murphy SM, Campbell ANC, Ghitza UE, Kyle TL, Bailey GL, Nunes DV, Polsky D. Cost-Effectiveness of an Internet-Delievered Treatment for Substance Abuse: Data from a Multisite Randomized Controlled Trial. Drug and Alcohol Dependence 2016 (in press).
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