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Oct. 24-26, 2005 Shepard@Brandeis Tel 781 736 3975 Brandeis University, Waltham MA 02454

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Oct. 24-26, 2005 Shepard@Brandeis Tel 781 736 3975 Brandeis University, Waltham MA 02454

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  1. 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 Shepard@Brandeis.edu Tel 781 736 3975 Brandeis University, Waltham MA 02454 Brandeis University

  2. 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

  3. 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

  4. Methods: Subjects • 359 Philadelphia adult alcohol or cocaine dependent clients • Had just completed intensive outpatient treatment. Brandeis University

  5. 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

  6. 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) Brandeis University

  7. Comparative intensity of interventions Brandeis University

  8. Average costs of interventions per client Brandeis University

  9. Results: Effectiveness Brandeis University

  10. Results: Cost-Effectiveness Brandeis University

  11. Results: Cost per incremental abstinent year Brandeis University

  12. Discussion: Program cost comparison

  13. Discussion: Societal cost comparison

  14. 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

  15. 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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