title: Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial.
abstract: OBJECTIVE
  To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse.
  
  
  METHODS
  Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes.
  
  
  RESULTS
  The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p<0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (-$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective.
  
  
  CONCLUSIONS
  TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States. Electronic address: shepard@brandeis.edu.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy & Management, Brandeis University, Waltham, MA 02454-9110, United States.
authors.forename: Marilyn C
authors.initials: MC
authors.lastname: Daley
authors.affiliation: U.S. Department of Veterans Affairs, Program Evaluation and Resource Center, VA Palo Alto Health Care System, Menlo Park Division, 795 Willow Road, Menlo Park, CA 94025, United States; U.S. Department of Veterans Affairs, Health Care Financing & Economics, VA Boston Health Care System, 150 South Huntington Avenue, Boston, MA 02130, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Neuman
authors.affiliation: Consultancy, 203 Candia Lane, Cary, NC 27519, United States.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Blaakman
authors.affiliation: University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, 3440 Market Street, Suite 370, Philadelphia, PA 19104, United States; U.S. Department of Veterans Affairs, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
mesh_terms: D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055502:Secondary Prevention / Q000191:economics; D019966:Substance-Related Disorders / Q000191:economics* / Q000628:therapy*; D013689:Telephone; D016896:Treatment Outcome
keywords: Alcohol and cocaine dependence; Continuing care alternatives; Relapse prevention; Telephone-based continuing care