Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs.

This study analyzes the cost-effectiveness of a prize-based contingency management intervention implemented within the CTN. The clinical trial, known within the CTN as Motivational Incentives for Enhanced Drug Abuse Recovery (MIEDAR), was implemented at eight community-based outpatient psychosocial substance abuse treatment clinics and included 415 stimulant abusers randomly assigned within each clinic to usual care or usual care plus prize-based contingency management (CM). Incremental cost-effectiveness ratios were estimated to compare prize-based incentives relative to usual care. The primary target drugs in the trial were cocaine, amphetamine, methamphetamine, and alcohol. The primary patient outcome was longest duration of confirmed stimulant abstinence (LDA). Results of the analysis show that the incremental cost to lengthen the LDA by 1 week was US $258.

This is one of the first substance abuse treatment studies to present an acceptability curve, which provides decision makers with information on when prize-based CM would be considered cost-effective. The acceptability curve indicates the likelihood an intervention will be “acceptable” to decision makers given a large set of alternative values (e.g. reductions in crime, disease, and welfare) that decision makers could place on the incremental outcome. For example, if the threshold value (perhaps determined by society’s willingness to pay) to extend the LDA by 1 week were US $205, then the prize-based CM intervention would be only 10% likely to be cost-effective. On the other hand, if the threshold value to extend the LDA by 1 week were US $325, then the prize-based CM intervention would be 90% likely to be cost-effective.

Related protocols: CTN-0007-A-2