title: Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial.
abstract: BACKGROUND
  Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES).
  
  
  METHODS
  Economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry).
  
  
  RESULTS
  From the provider's perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable.
  
  
  CONCLUSIONS
  With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy.
authors.affiliation: Department of Health Policy and Administration, Washington State University, Spokane, WA, USA. Electronic address: sean.murphy@wsu.edu.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Aimee N C
authors.initials: AN
authors.lastname: Campbell
authors.affiliation: Center for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA.
authors.forename: Udi E
authors.initials: UE
authors.lastname: Ghitza
authors.affiliation: Aspire Health Partners, Orlando, FL, USA.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Kyle
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA; Stanley Street Treatment and Resources, Fall River, MA, USA.
authors.forename: Genie L
authors.initials: GL
authors.lastname: Bailey
authors.affiliation: New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D019057:Quality-Adjusted Life Years; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome
keywords: Community reinforcement approach; Contingency management; Cost effectiveness; Internet-based intervention; Substance use disorders