title: Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment.
abstract: Thirty-six newly abstinent married male alcoholics, who had recently begun outpatient individual alcoholism counseling, were randomly assigned to a no-marital-therapy control group or to 10 weekly sessions of a behavioral marital therapy (BMT) or an interactional couples group. The cost-benefit analysis of BMT plus individual alcoholism counseling showed (a) decreases in health care and legal costs in the 2 years after as compared to the year before treatment, (b) a positive cost offset, and (c) a benefit-to-cost ratio greater than 1 indicating that health and legal system cost savings (i.e., benefits) exceeded the cost of delivering the BMT treatment. None of the positive cost-benefit results observed for BMT were true for participants given interactional couples therapy plus individual alcoholism counseling for which posttreatment utilization costs increased. Thus, adding BMT to individual alcoholism counseling produced a positive cost benefit, whereas the addition of interactional couples therapy did not. Individual counseling both alone and with BMT added showed substantial and significant cost savings from reduced utilization that substantially and significantly exceeded the cost of delivering the treatment; and the two treatments did not differ significantly on these cost savings and cost offsets. Individual counseling alone did have a significantly more positive benefit-to-cost ratio than BMT plus individual counseling due to the lower cost of delivering the individual counseling which was about half the cost of delivering BMT plus individual counseling. Cost-effectiveness analyses indicated that BMT plus individual counseling was less cost effective than individual counseling alone and modestly more cost effective than interactional therapy in producing abstinence from drinking. When marital adjustment outcomes were considered, the three treatments were equally cost effective except during the active treatment phase when BMT was more cost effective than interactional couples therapy. Study limitations are discussed.
authors.affiliation: Harvard Families and Addiction Program, Harvard Medical School Department of Psychiatry, Brockton, MA 02401, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: O'Farrell
authors.forename: K A
authors.initials: KA
authors.lastname: Choquette
authors.forename: H S
authors.initials: HS
authors.lastname: Cutter
authors.forename: F J
authors.initials: FJ
authors.lastname: Floyd
authors.forename: R
authors.initials: R
authors.lastname: Bayog
authors.forename: E D
authors.initials: ED
authors.lastname: Brown
authors.forename: J
authors.initials: J
authors.lastname: Lowe
authors.forename: A
authors.initials: A
authors.lastname: Chan
authors.forename: P
authors.initials: P
authors.lastname: Deneault
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000191:economics / Q000534:rehabilitation*; D000553:Ambulatory Care / Q000191:economics*; D001521:Behavior Therapy / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008388:Marital Therapy / Q000191:economics*; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000191:economics