Cost and cost-effectiveness of three strategies for training clinicians in motivational interviewing

Abstract

Objective: To evaluate the cost and cost-effectiveness of three strategies for teaching community program clinicians motivational interviewing (MI): self-study (SS), expert-led (EX), and train-the-trainer (TT).

Methods: This economic analysis was conducted as part of a three-arm clinician training trial comprising 12 community treatment programs randomly assigned to the three conditions (n=92 clinician participants). EX and TT conditions used skill-building workshops and three monthly supervision sessions. SS provided clinicians MI training materials only. The primary outcome measure was the number of clinicians meeting MI performance standards at 12-week follow-up. Unit costs were obtained via surveys administered at the 12 participating programs. Resource utilizations and clinician outcomes were obtained from the training trial. Costs and outcomes were normalized to account for differing numbers of clinicians across programs and conditions. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to evaluate the relative cost-effectiveness of the three training strategies.

Results: SS is likely to be the most cost-effective training strategy if the threshold value to decision makers of an additional clinician meeting MI performance standards at 12-week follow-up is less than approximately $2870, and EX is likely to be the most cost-effective strategy when the threshold value is greater than approximately $2870.

Conclusions: This study provides accurate estimates of the economic costs and relative cost-effectiveness of three different strategies for training community program clinicians in motivational interviewing and should be of interest to decision makers seeking to implement empirically supported addiction treatments with scarce resources.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Cost-effectiveness acceptability curves for clinicians meeting MI performance standards based on one cohort (a), and twenty-five cohorts (b). For a given threshold value, the probability of being cost effective is equivalent to the proportion of the 2,000 bootstrapped replicates for which each training strategy (SS, EX, and TT) had the highest net benefit (Fenwick et al., 2001).