title: Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction.
abstract: OBJECTIVE
  To determine the cost-effectiveness, from clinic and patient perspectives, of a computer-based version of cognitive-behavioral therapy (CBT4CBT) as an addition to regular clinical practice for substance dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: This cost-effectiveness study is based on a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to treatment as usual (TAU) or TAU plus biweekly access to computer-based training in CBT (TAU plus CBT4CBT). The primary patient outcome measure was the total number of drug-free specimens provided during treatment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were used to determine the cost-effectiveness of TAU plus CBT4CBT relative to TAU alone. Results are presented from both the clinic and patient perspectives and are shown to be robust to (i) sensitivity analyses and (ii) a secondary objective patient outcome measure.
  
  
  RESULTS
  The per patient cost of adding CBT4CBT to standard care was $39 ($27) from the clinic (patient) perspective. From the clinic (patient) perspective, TAU plus CBT4CBT is likely to be cost-effective when the threshold value to decision makers of an additional drug-free specimen is greater than approximately $21 ($15), and TAU alone is likely to be cost-effective when the threshold value is less than approximately $21 ($15). The ICERs for TAU plus CBT4CBT also compare favorably to ICERs reported elsewhere for other empirically validated therapies, including contingency management.
  
  
  CONCLUSIONS
  TAU plus CBT4CBT appears to be a good value from both the clinic and patient perspectives.
authors.affiliation: George Mason University, School of Public Policy, 3401 Fairfax Drive, Arlington, VA 22201, USA. olmstead@gmu.edu
authors.forename: Todd A
authors.initials: TA
authors.lastname: Olmstead
authors.forename: Cary D
authors.initials: CD
authors.lastname: Ostrow
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D016739:Behavior, Addictive / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000628:therapy*; D013695:Temperance; D013813:Therapy, Computer-Assisted / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Drug Alcohol Depend. 2009 Feb 1;100(1-2):178-81
references.pmid: 19041197
references.citation: J Subst Abuse Treat. 2003 Sep;25(2):117-21
references.pmid: 14680015
references.citation: Health Econ. 2001 Mar;10(2):179-84
references.pmid: 11252048
references.citation: J Consult Clin Psychol. 2006 Oct;74(5):955-66
references.pmid: 17032099
references.citation: Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31
references.pmid: 17035245
references.citation: Arch Gen Psychiatry. 2004 Mar;61(3):264-72
references.pmid: 14993114
references.citation: Am J Psychiatry. 2008 Jul;165(7):881-8
references.pmid: 18450927
references.citation: Biol Psychiatry. 2004 Nov 15;56(10):764-70
references.pmid: 15556121
references.citation: Arch Gen Psychiatry. 1994 Dec;51(12):989-97
references.pmid: 7979888
references.citation: JAMA. 2006 May 3;295(17):2003-17
references.pmid: 16670409
references.citation: Psychol Addict Behav. 2001 Jun;15(2):83-8
references.pmid: 11419234
references.citation: Drug Alcohol Depend. 2009 Jun 1;102(1-3):108-15
references.pmid: 19324501
references.citation: J Consult Clin Psychol. 1999 Aug;67(4):563-70
references.pmid: 10450627
references.citation: J Consult Clin Psychol. 2005 Feb;73(1):106-15
references.pmid: 15709837
references.citation: Drug Alcohol Depend. 2007 Mar 16;87(2-3):175-82
references.pmid: 16971054
references.citation: Addiction. 2007 Sep;102(9):1463-71
references.pmid: 17645428
references.citation: Br J Psychiatry. 2004 Jul;185:55-62
references.pmid: 15231556
references.citation: Addiction. 2007 Sep;102(9):1443-53
references.pmid: 17645430
references.citation: J Subst Abuse Treat. 2008 Dec;35(4):369-79
references.pmid: 18337053
references.citation: Health Econ. 2001 Dec;10(8):779-87
references.pmid: 11747057
references.citation: Drug Alcohol Depend. 2009 Jan 1;99(1-3):132-40
references.pmid: 18804923
references.citation: JAMA. 2000 Oct 4;284(13):1689-95
references.pmid: 11015800
references.citation: Arch Gen Psychiatry. 2006 Aug;63(8):925-34
references.pmid: 16894069
references.citation: Am J Psychiatry. 2005 Aug;162(8):1452-60
references.pmid: 16055766
references.citation: J Consult Clin Psychol. 1998 Feb;66(1):37-52
references.pmid: 9489261