Abstract
Objectives: Cost-effectiveness analysis of two 12-week contingency management (CM) schedules targeting heroin abstinence or attendance at weekly keyworker appointments for opioid agonist treatment compared with treatment as usual (TAU).
Methods: A cost-effectiveness analysis was conducted alongside a cluster randomized trial of 552 patients from 34 clusters (drug treatment clinics) randomly allocated 1:1:1 to opioid agonist treatment plus weekly keyworker appointments with (1) CM targeted at heroin abstinence (CM abstinence), (2) CM targeted at on-time attendance at weekly appointments (CM attendance), or (3) no CM (TAU). The primary cost-effectiveness analysis at 24 weeks after randomization took a societal cost perspective with effects measured in heroin-negative urine samples.
Results: At 24 weeks, mean differences in weekly heroin-negative urine results compared with TAU were 0.252 (95% confidence interval [CI] −0.397 to 0.901) for CM abstinence and 0.089 (95% CI −0.223 to 0.402) for CM attendance. Mean differences in costs were £2562 (95% CI £32-£5092) for CM abstinence and £317 (95% CI −£882 to £1518) for CM attendance. Incremental cost-effectiveness ratios were £10 167 per additional heroin-free urine for CM abstinence and £3562 for CM attendance with low probabilities of cost-effectiveness of 3.5% and 36%, respectively. Results were sensitive to timing of follow-up for CM attendance, which dominated TAU (better outcomes, lower costs) at 12 weeks, with an 88.4% probability of being cost-effective. Probability of cost-effectiveness remained low for CM abstinence (8.6%).
Conclusions: Financial incentives targeted toward heroin abstinence and treatment attendance were not cost-effective over the 24-week follow-up. Nevertheless, CM attendance was cost-effective over the treatment period (12 weeks), when participants were receiving keyworker appointments and incentives.
Original language | English |
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Pages (from-to) | 658-665 |
Number of pages | 8 |
Journal | Value in Health |
Volume | 26 |
Issue number | 5 |
Early online date | 9 Dec 2022 |
DOIs | |
Publication status | Published - May 2023 |
Bibliographical note
Funding Information:Conflict of Interest Disclosures: Dr Metrebian reported receiving grants from the National Institute for Health and Care Research (NIHR) during the conduct of the study; grants from NIHR, Society for Study on Addiction, and Mundipharma Research Ltd; and other from Mayne Pharma International outside the submitted work. Dr Goldsmith reported receiving grants from NIHR during the conduct of the study and grants from NIHR, MRC, Juvenile Diabetes Research Foundation Ltd, UKRI, National Institutes of Health (United States), and the Stroke Association outside the submitted work. Dr Strang reported receiving grants from MundiPharma, Camurus, Molteni/Accord, and NIHR and other from Maudsley NHS Foundation Trust, King's College London, and NIHR Biomedical Research Centre for Mental Health at South London outside the submitted work. Dr Pilling reported receiving grants from National Institute for Health and Care Excellence and Royal Society of Psychiatrists outside the submitted work. Dr Mitcheson reported receiving grants as coinvestigator on a trial of depot buprenorphine funded by Indiviour, the product manufacturer; as collaborator on an NIHR-funded project looking at co-occurring mental health and substance use outside the submitted work; and as clinical advisor seconded to the Office of Health Improvement and Disparities in the Department of Health and Social Care. Dr Day reported receiving grants from the NIHR during the conduct of the study and as a consultant psychiatrist in a specialist addiction service in the NHS. Dr Byford reported receiving grants from NIHR during the conduct of the study. No other disclosures were reported. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
This article presents independent research funded by NIHR under its Programme Grants for Applied Research Programme (grant reference number RP-PG-0707-10149). This article represents independent research part funded by NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London and by the Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust.
Publisher Copyright:
© 2023
Keywords
- cluster randomized trial
- contingency management
- cost-effectiveness analysis
- opioid agonist treatment
ASJC Scopus subject areas
- Health Policy
- Public Health, Environmental and Occupational Health