Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults

Abstract

Introduction: The study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period.

Methods: Intervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement.

Results: From the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake.

Conclusions: Telephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness.

Clinical trial registration: Clinical Trials.gov Number: NCT00685659.

Keywords: Continuing care; Cost-effectiveness analysis; Economic evaluation; Substance use disorders.

Conflict of interest statement

Conflict of interest

No conflict declared.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Figures

Fig. 1

Cost-effectiveness acceptability curve (CEAC) for abstinence.