Internet-Delivered Treatment for SUD Found to be Cost-Effective

• Drug and alcohol use disorders are one of the costliest health problems in the U.S. Effective treatments for substance use disorders exist but face a number of barriers to successful implementation, including lack of access and concerns about stigma.
• Internet-based interventions have the potential to address some of these barriers by delivering treatment of high quality at low cost, with limited burden on clinical staff, and in more private settings.

CTN-0044, “Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders,” was one of the first large, multi-site effectiveness trials of a computer-delivered intervention for substance use disorders. It evaluated the effectiveness of the Therapeutic Education System (TES), a web-based version of the Community Reinforcement Approach (CRA) intervention plus contingency management. The hypothesis was that TES, when used as a substitute for some clinician-delivered sessions in treatment as usual (TAU), would both improve outcomes and reduce dropout compared to TAU alone alone. Outcomes from the original trial, published in 2014 (Campbell, et al., 2014), found that compared with patients in the treatment-as-usual (TAU) group, those in the group that involved TAU plus access to the Therapeutic Education System (TAU+TES) had a lower drop-out rate and a greater abstinence rate. The results supported the promise of the intervention as a useful tool in the addiction treatment system. A new article (Murphy et al., 2016) reports on a secondary analysis of CTN-0044, evaluating its cost-effectiveness over the 12-week initial trial period as well as at follow-up at 24 and 36 weeks. The analysis found that, from the provider’s perspective, TES+TAU as implemented in the original trial costs $278 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-only participants. In terms of “abstinent years,” a commonly-used measure in cost-effectiveness evaluations, 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.” Conclusions: With regard to the clinical outcome of abstinence, these cost-effectiveness findings compare favorably to those found elsewhere in the literature about contingency management. 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. Read more in the CTN Dissemination Library! http://ctndisseminationlibrary.org