Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction.
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.
Olmstead
Todd A
TA
George Mason University, School of Public Policy, 3401 Fairfax Drive, Arlington, VA 22201, USA. olmstead@gmu.edu
Ostrow
Cary D
CD
Carroll
Kathleen M
KM
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
Drug Alcohol Depend. 2009 Feb 1;100(1-2):178-81
19041197
J Subst Abuse Treat. 2003 Sep;25(2):117-21
14680015
Health Econ. 2001 Mar;10(2):179-84
11252048
J Consult Clin Psychol. 2006 Oct;74(5):955-66
17032099
Alcohol Alcohol. 2006 Nov-Dec;41(6):624-31
17035245
Arch Gen Psychiatry. 2004 Mar;61(3):264-72
14993114
Am J Psychiatry. 2008 Jul;165(7):881-8
18450927
Biol Psychiatry. 2004 Nov 15;56(10):764-70
15556121
Arch Gen Psychiatry. 1994 Dec;51(12):989-97
7979888
JAMA. 2006 May 3;295(17):2003-17
16670409
Psychol Addict Behav. 2001 Jun;15(2):83-8
11419234
Drug Alcohol Depend. 2009 Jun 1;102(1-3):108-15
19324501
J Consult Clin Psychol. 1999 Aug;67(4):563-70
10450627
J Consult Clin Psychol. 2005 Feb;73(1):106-15
15709837
Drug Alcohol Depend. 2007 Mar 16;87(2-3):175-82
16971054
Addiction. 2007 Sep;102(9):1463-71
17645428
Br J Psychiatry. 2004 Jul;185:55-62
15231556
Addiction. 2007 Sep;102(9):1443-53
17645430
J Subst Abuse Treat. 2008 Dec;35(4):369-79
18337053
Health Econ. 2001 Dec;10(8):779-87
11747057
Drug Alcohol Depend. 2009 Jan 1;99(1-3):132-40
18804923
JAMA. 2000 Oct 4;284(13):1689-95
11015800
Arch Gen Psychiatry. 2006 Aug;63(8):925-34
16894069
Am J Psychiatry. 2005 Aug;162(8):1452-60
16055766
J Consult Clin Psychol. 1998 Feb;66(1):37-52
9489261