Oct 24 26 2005 shepard@brandeis edu tel 781 736 3975 brandeis university waltham ma 02454
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Oct 24 26 2005 shepard@brandeis edu tel 781 736 3975 brandeis university waltham ma 02454

Cost-effectiveness of telephone counseling and relapse prevention for cocaine or alcohol dependent clientsDonald S Shepard1Aaron Beaston-Blaakman2 James McKay31 Brandeis University, Schneider Institute for Health Policy, Waltham, MA2 Family Health International, Research Triangle Park, NC3 University of Pennsylvania, Philadelphia, PA

Oct. 24-26, 2005

[email protected]

Tel 781 736 3975

Brandeis University, Waltham MA 02454

Brandeis University


Introduction cost effectiveness analysis cea
Introduction: prevention for cocaine or alcohol dependent clientsCost-Effectiveness Analysis (CEA)

Cost-effectiveness analyses (CEA) seek to help programs and payers allocate shrinking resources for substance abuse treatment most effectively.

Brandeis University


Methods design
Methods: Design prevention for cocaine or alcohol dependent clients

  • Random assignment study

  • Each approach entailed 1-2 counseling initial contacts per week

  • Each intervention lasted 12 weeks

  • Quarterly research follow-up over 2 years

Brandeis University


Methods subjects
Methods: Subjects prevention for cocaine or alcohol dependent clients

  • 359 Philadelphia adult alcohol or cocaine dependent clients

  • Had just completed intensive outpatient treatment.

Brandeis University


Methods interventions
Methods: Interventions prevention for cocaine or alcohol dependent clients

  • Standard care (standard group continuing care, STND) was the reference against which the two newer approaches to continuing care were compared.

  • Relapse prevention emphasized individual in-person sessions (RP)

  • Telephone counseling (TEL) delivered most sessions by phone with the fewest minutes of therapeutic contact.

Brandeis University


Methods costs
Methods: Costs prevention for cocaine or alcohol dependent clients

  • Program costs were assessed with a preliminary version of the Treatment Cost Analysis Tool (TCAT).

  • Following recommended CE guidelines, societal costs were also included.

  • Clients’ travel expenses averaged $2.75 per round trip (bulk tickets on Philadelphia public transport)

  • Clients’ time in treatment, waiting, and travel were valued at Pennsylvania minimum wage ($5.65/hr)

Brandeis University


Comparative intensity of interventions
Comparative intensity of interventions prevention for cocaine or alcohol dependent clients

Brandeis University


Average costs of interventions per client
Average costs of interventions per client prevention for cocaine or alcohol dependent clients

Brandeis University


Results effectiveness
Results: Effectiveness prevention for cocaine or alcohol dependent clients

Brandeis University


Results cost effectiveness
Results: Cost-Effectiveness prevention for cocaine or alcohol dependent clients

Brandeis University


Results cost per incremental abstinent year
Results: Cost per incremental abstinent year prevention for cocaine or alcohol dependent clients

Brandeis University


Discussion program cost comparison
Discussion: Program cost comparison prevention for cocaine or alcohol dependent clients


Discussion societal cost comparison
Discussion: Societal cost comparison prevention for cocaine or alcohol dependent clients


Results cost effectiveness1
Results: Cost-Effectiveness prevention for cocaine or alcohol dependent clients

  • In terms of program costs only, TEL was most cost-effective

  • In overall cost per client, moreover, TEL, which minimized client time, was least expensive ($571), STND was intermediate ($678), while RP remained most costly ($1665).

Brandeis University


Conclusions
Conclusions prevention for cocaine or alcohol dependent clients

  • TEL was economically superior to (i.e., dominated) the other approaches in generating better outcomes with less total resources.

  • Telephone-based counseling appears to be a highly cost-effective approach to continuing care (aftercare) in alcohol and cocaine dependent patients.

Brandeis University


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