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: Cost-Effectiveness Analysis (CEA)

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

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Methods design

Methods: Design

  • 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

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Methods subjects

Methods: Subjects

  • 359 Philadelphia adult alcohol or cocaine dependent clients

  • Had just completed intensive outpatient treatment.

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Methods interventions

Methods: Interventions

  • 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.

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Methods costs

Methods: Costs

  • 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)

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Comparative intensity of interventions

Comparative intensity of interventions

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Average costs of interventions per client

Average costs of interventions per client

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Results effectiveness

Results: Effectiveness

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Results cost effectiveness

Results: Cost-Effectiveness

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Results cost per incremental abstinent year

Results: Cost per incremental abstinent year

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Discussion program cost comparison

Discussion: Program cost comparison

Discussion societal cost comparison

Discussion: Societal cost comparison

Results cost effectiveness1

Results: Cost-Effectiveness

  • 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).

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  • 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.

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