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Randomized Controlled Trial
. 2023 Mar 1:244:109754.
doi: 10.1016/j.drugalcdep.2022.109754. Epub 2022 Dec 23.

Cost and cost-effectiveness of abstinence contingent wage supplements

Stephen Orme  1 , Gary A Zarkin  2 , Jackson Luckey  2 , Laura J Dunlap  2 , Matthew D Novak  3 , August F Holtyn  3 , Forrest Toegel  3 , Kenneth Silverman  3
Affiliations
Randomized Controlled Trial

Cost and cost-effectiveness of abstinence contingent wage supplements

Stephen Orme et al. Drug Alcohol Depend. .

Erratum in

Abstract

Background: Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care.

Methods: To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment.

Results: ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915.

Conclusions: ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.

Keywords: Cocaine; Contingency management; Cost-effectiveness; Employment; Opioids; Therapeutic workplace.

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Conflict of interest statement

Conflict of interest No conflicts declared.

Figures

Fig 1a.
Fig 1a.
Cost-Effectiveness Acceptability Curves (CEACs) for Negative Drug Test and Total Participant Cost at End the Intervention Period.
Fig. 1b.
Fig. 1b.
Cost-Effectiveness Acceptability Curves (CEACs) for Employment and Total Participant Cost at End of Intervention Period.
Fig. 2a.
Fig. 2a.
Cost-Effectiveness Acceptability Curves (CEACs) for Negative Drug Test and Total Participant Cost at the End of Post-Intervention Period.
Fig. 2b.
Fig. 2b.
Cost-Effectiveness Acceptability Curves (CEACs) for Employment and Total Participant Cost at the End of Post-Intervention Period.
See this image and copyright information in PMC

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