Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs

Abstract

Objective-To evaluate the cost-effectiveness of a prize-based intervention as an addition to usual care for stimulant abusers.Methods-This cost-effectiveness analysis is based on a randomized clinical trial implemented within the National Drug Abuse Treatment Clinical Trials Network. The trial was conducted at eight community-based outpatient psychosocial drug abuse treatment clinics. 415 stimulant abusers were assigned to usual care (n = 206) or usual care plus abstinence-based incentives (n=209) for 12 weeks. Participants randomized to the incentive condition earned the chance to draw for prizes for submitting substance negative samples; the number of draws earned increased with continuous abstinence time. Incremental cost-effectiveness ratios were estimated to compare prize-based incentives relative to usual care. The primary patient outcome was longest duration of confirmed stimulant abstinence (LDA). Unit costs were obtained via surveys administered at the eight participating clinics. Resource utilizations and patient outcomes were obtained from the clinical trial. Acceptability curves are presented to illustrate the uncertainty due to the sample and to provide policy relevant information.Results-The incremental cost to lengthen the LDA by one week was $258 (95% confidence interval, $191 -$401). Sensitivity analyses on several key parameters show that this value ranges from $163 to $269.Conclusions-Compared with the usual care group, the incentive group had significantly longer LDAs and significantly higher costs.

Contingency management in substance abuse treatment: A structured review of the evidence for its transportability

“…Concern over basic costs of implementation—incentive purchasing/storage, toxicology screens, and staff time—are salient (Kirby et al, 1999; Kirby et al, 2006; Roll et al, 2009) and a common reason clinics forego adoption (Roman et al, 2010; Walker et al, 2010). Cost-effectiveness studies compare CM vs. treatment-as-usual (Olmstead et al, 2007b), other approaches (Olmstead et al, 2007a), or even contrast CM systems (Sindelar et al, 2007a). Some specify incremental implementation costs per outcome (Olmstead and Petry, 2009; Sindelar et al, 2007b).…”

A New Frontier: Integrating Behavioral and Digital Technology to Promote Health Behavior

“…Although the cost of monetary incentives is often viewed as a barrier to dissemination (Petry and Simcic 2002), research in the field of substance abuse suggests that CM interventions are cost-effective (Olmstead et al 2007a, b; Sindelar et al 2007). No study has assessed the cost-effectiveness of technology-based CM procedures.…”

An economic evaluation of a contingency-management intervention for stimulant use among community mental health patients with serious mental illness

“…Information regarding the cost-effectiveness of CM is needed to inform policymakers who are increasingly making decisions about the availability of such treatments based on their clinical and cost effectiveness (Petry et al, 2014). Previous cost-effectiveness analyses (CEAs) on CM have been favorable, but have focused on its application to the treatment of specific drugs rather than co-occurring SMI and SUD, and have focused solely on clinical measures for the effectiveness outcome, such as abstinence or treatment completion (Olmstead and Petry, 2009; Olmstead et al, 2007a, 2007b, c; Sindelar et al, 2007a, 2007b). No studies to date have investigated the cost-effectiveness of CM for individuals with comorbid SMI and SUD, a particularly costly population.…”