Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Apr 1:161:119-26.
doi: 10.1016/j.drugalcdep.2016.01.021. Epub 2016 Jan 30.

Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial

Sean M Murphy  1 , Aimee N C Campbell  2 , Udi E Ghitza  3 , Tiffany L Kyle  4 , Genie L Bailey  5 , Edward V Nunes  2 , Daniel Polsky  6
Affiliations
Randomized Controlled Trial

Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial

Sean M Murphy et al. Drug Alcohol Depend. .

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.

Trial registration: ClinicalTrials.gov NCT01104805.

Keywords: Community reinforcement approach; Contingency management; Cost effectiveness; Internet-based intervention; Substance use disorders.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

Dr. Nunes has received medication for research studies from Alkermes/Cephalon, Duramed Pharmaceuticals, and Reckitt-Benckiser. Dr. Polsky has served on an advisory panel for Pfizer and as a consultant for Accenture. Udi E. Ghitza is an employee of the Center for the Clinical Trials Network, NIDA, which is the funding agency for the National Drug Abuse Treatment Clinical Trials Network. NIDA staff’s (Udi E. Ghitza’s) participation in this publication arises from his role as a project scientist on a cooperative agreement (this WEB-TX CTN study), which provided the data that were analyzed for this publication, but Udi E. Ghitza has not had and will not have any programmatic involvement with the grants cited. The opinions in this paper are those of the authors and do not represent the official position of the U.S. government. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Acceptability Curve for Cost per Abstinent Year – All Participants
Figure 2
Figure 2
Acceptability Curve for Cost per Abstinent Year – Participants Not Abstinent at Study Entry
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Albright J, Ciaverelli R, Essex A, Tkacz J, Ruetsch C. Psychiatrist characteristics that influence use of buprenorphine medication-assisted treatment. J Addict Med. 2010;4:197–203. - PubMed
    1. Bewick BM, Trusler K, Barkham M, Hill AJ, Cahill J, Mulhern B. The effectiveness of web-based interventions designed to decrease alcohol consumption—a systematic review. Prev Med. 2008;47:17–26. - PubMed
    1. Bickel WK, Amass L, Higgins ST, Badger GJ, Esch RA. Effects of adding behavioral treatment to opioid detoxification with buprenorphine. J Consult Clin Psychol. 1997;65:803. - PubMed
    1. Bickel WK, Marsch LA, Buchhalter AR, Badger GJ. Computerized behavior therapy for opioid-dependent outpatients: a randomized controlled trial. Exp Clin Pharmacol. 2008;6:132. - PMC - PubMed
    1. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the U.S., 2006. Am J Prev Med. 2011;41:516–524. - PubMed

Publication types

Associated data