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.

Brandeis University

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

Brandeis University

methods subjects
Methods: Subjects
  • 359 Philadelphia adult alcohol or cocaine dependent clients
  • Had just completed intensive outpatient treatment.

Brandeis University

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.

Brandeis University

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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results effectiveness
Results: Effectiveness

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results cost effectiveness
Results: Cost-Effectiveness

Brandeis University

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).

Brandeis University

conclusions
Conclusions
  • 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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