Cost-effectiveness of prize-based contingency management in methadone maintenance treatment programs.
OBJECTIVE
To determine if prize-based contingency management (CM), which has been shown to improve treatment outcomes over usual care (UC) alone, is cost-effective.


METHODS
A cost-effectiveness study of a multi-site clinical trial. Data on the outcome measures came from the original effectiveness trial. Cost data were gathered by clinic survey specifically for this cost-effectiveness analysis.


METHODS
Six methadone maintenance community clinics participating in the National Drug Abuse Treatment Clinical Trials Network.


METHODS
Participants were recruited from six methadone maintenance community treatment programs. The study sample consisted of 388 participants: 190 in the UC condition and 198 in the CM condition. Participants were randomized at each site to either the UC or the CM condition based on the presence of stimulants (cocaine, amphetamine or methamphetamine) and opioids in their baseline urine sample.


METHODS
Prize-based contingency management added to usual care.


METHODS
Longest duration of abstinence (LDA), number of stimulant-negative urine samples and costs of treatment.


RESULTS
Compared to usual care, the incremental cost of using prize-based CM to lengthen the LDA by 1 week was $141 [95% confidence interval (CI), $105-$193]. The incremental cost to obtain an additional stimulant-negative urine sample was $70 (95% CI, $53-$117).


CONCLUSIONS
By comparing this study to a companion study, we found that adding prize-based CM to usual care may be more cost-effective in methadone maintenance clinics than in counseling-based drug-free clinics.
Sindelar
Jody L
JL
School of Public Health and Medical School, Yale University, New Haven, CT 06520-8034, USA. jody.sindelar@yale.edu
Olmstead
Todd A
TA
Peirce
Jessica M
JM
D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care; D012201:Reward; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone