title: An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.
abstract: To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources.
  
  
  
  A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection.
  
  
  
  Data on attendance to vaccination from a UK cluster randomized trial.
  
  
  
  Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives.
  
  
  
  Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios.
  
  
  
  The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000).
  
  
  
  Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%.
authors.affiliation: Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Rachid
authors.initials: R
authors.lastname: Rafia
authors.affiliation: Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dodd
authors.affiliation: Health Economics and Decision Science (HEDS), School of Health and Related Research, (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Brennan
authors.affiliation: Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Petra S
authors.initials: PS
authors.lastname: Meier
authors.affiliation: Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and Control, Public Health UK (PHE), London, UK.
authors.forename: Vivian D
authors.initials: VD
authors.lastname: Hope
authors.affiliation: Injecting Drug Use Team, HIV and STI Department, Centre for Infectious Disease, Surveillance and Control, Public Health UK (PHE), London, UK.
authors.forename: Fortune
authors.initials: F
authors.lastname: Ncube
authors.affiliation: Centre for the Economics of Mental and Physical Health, King's College London, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.affiliation: Centre for the Economics of Mental and Physical Health, King's College London, London, UK.
authors.forename: Hiong
authors.initials: H
authors.lastname: Tie
authors.affiliation: National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Metrebian
authors.affiliation: Department of Biostatistics, King's College London, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hellier
authors.affiliation: Department of Mental Health, Social Work and Integrative Medicine, Middlesex University, Hendon, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Weaver
authors.affiliation: National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Strang
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019468:Disease Management; D017048:Health Care Costs; D006509:Hepatitis B / Q000150:complications / Q000191:economics / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D008113:Liver Neoplasms / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics; D008390:Markov Chains; D009026:Mortality; D009042:Motivation; D009293:Opioid-Related Disorders / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D015819:Substance Abuse, Intravenous / Q000628:therapy*; D006113:United Kingdom
chemical_list: D017325:Hepatitis B Vaccines
keywords: Contingency management; economic; incentives; injecting; methadone maintenance program; opiates; vaccination; viral hepatitis