Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial. (1st April 2016)

• Record Type: Journal Article
• Authors: Murphy, Sean M.; Campbell, Aimee N.C.; Ghitza, Udi E.; Kyle, Tiffany L.; Bailey, Genie L.; Nunes, Edward V.; Polsky, Daniel
• Is Part Of: Drug and alcohol dependence. Volume 161(2016)
• Page Start: 119
• Page End: 126
• Publication Date: 2016-04-01
• Subjects: Substance use disorders -- Internet-based intervention -- Cost effectiveness -- Community reinforcement approach -- Contingency management; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2016.01.021
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Therapeutic Education System (TES)—internet-based substance-misuse intervention. We conducted an economic evaluation of a multisite randomized trial of TES. Evaluated TES as treatment for alcohol or other substance use disorders. TES is likely cost-effective based on the clinical outcome of abstinence. Abstract: 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.