title: An economic evaluation of a contingency-management intervention for stimulant use among community mental health patients with serious mental illness.
abstract: BACKGROUND
  This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependence among community mental health patients with serious mental illness (SMI) METHODS: Economic evaluation of a 12-week randomized controlled trial investigating the efficacy of CM added to treatment-as-usual (CM+TAU), relative to TAU without CM, for treating stimulant dependence among patients with a SMI. The trial included 176 participants diagnosed with SMI and stimulant dependency who were receiving community mental health and addiction treatment at one community mental health center in Seattle, Washington. Participants were also assessed during a 12-week follow-up period. Positive and negative syndrome scale (PANSS) scores were used to calculate quality-adjusted life-years (QALYs) for the primary economic outcome. The primary clinical outcome, the stimulant-free year (SFY) is a weighted measure of time free from stimulants. Two perspectives were adopted, those of the provider and the payer.
  
  
  RESULTS
  At 12-weeks neither the provider ($2652, p=0.74) nor the payer ($2611, p=0.99) cost differentials were statistically significant. This was also true for the payer at 24-weeks (-$125, p=1.00). QALYs gained were similar across groups, resulting in small, insignificant differences (0.04, p=0.23 at 12-weeks; 0.01, p=0.70 at 24 weeks). CM+TAU experienced significantly more SFYs, 0.24 (p<0.001) at 12 weeks and 0.20 (p=0.002) at 24 weeks, resulting in at least an 85% chance of being considered cost-effective at a threshold of $200,000/SFY.
  
  
  CONCLUSIONS
  Contingency management appears to be a wise investment for both the provider and the payer with regard to the clinical outcome of time free from stimulants.
authors.affiliation: Program of Excellence in Addictions Research, Washington State University, Spokane, WA 99210, USA. Electronic address: sean.murphy@wsu.edu.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: McDonell
authors.affiliation: Program of Excellence in Addictions Research, Washington State University, Spokane, WA 99210, USA.
authors.forename: Sterling
authors.initials: S
authors.lastname: McPherson
authors.affiliation: King County Mental Health, Chemical Abuse and Dependency Services Division, Seattle, WA 98104, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Srebnik
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Angelo
authors.affiliation: Program of Excellence in Addictions Research, Washington State University, Spokane, WA 99210, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Roll
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Ries
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000191:economics*; D000697:Central Nervous System Stimulants / Q000191:economics*; D003156:Community Mental Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000191:economics* / Q000628:therapy; D019057:Quality-Adjusted Life Years; D019966:Substance-Related Disorders / Q000150:complications / Q000191:economics* / Q000628:therapy; D014861:Washington
chemical_list: D000697:Central Nervous System Stimulants
keywords: Contingency management; Cost effectiveness; Serious mental illness; Stimulant use