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National Collaborating Centre for Mental Health (UK). Drug Misuse: Psychosocial Interventions. Leicester (UK): British Psychological Society; 2008. (NICE Clinical Guidelines, No. 51.)

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Drug Misuse: Psychosocial Interventions.

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APPENDIX 13EVIDENCE TABLES FOR ECONOMIC STUDIES

Study ID and countryIntervention detailsStudy population setting study design – data sourceStudy typeCosts: description and values outcomes: description and valuesResults: cost- effectivenessComments internal validity (Yes/No/NA) industry support
Bloom et al., 1993Three hepatitis B vaccination strategies (no vaccination, universal vaccination, screen and vaccinate)Different strategies evaluated in four populations (newborns, 10 years old, high-risk population, general adult US)
Model: decision tree 30 years time horizon Revaccination every 10 years
Cost- effectiveness analysisCosts: direct medical costs only Perspective of health care payer. For universal vaccination to be cost saving cost per dose should be: US$7 (general population), US$13 (adolescent population), US$34 (newborns)Cost per life year saved (US$1,993)
Vaccination strategies:

newborns (all): US$3,066

newborns (screen and vaccinate): US$3,332

  • adolescents (all): US$13,938
  • adults (all): US$54,524 adults (screen and vaccinate): US$59,101
Vaccination is dominant strategy for adult high-risk populations and neonates
Sensitivity analysis: scenario analysis Costs or savings are sensitive to the costs of hepatitis B vaccine and administration
Discounting: cost and outcomes at 5% per year

Internal validity: 19/14/2
Castelnuovo et al., 2006Treatment: case finding and treatment on progression of hepatitis C virus

Comparator: Spontaneous presentation for testing
Former injecting drug users in the UK (average age =37)
Hypothetical cohort (N =1,000)
Cost- effectiveness analysisCosts: NHS perspective Systematic offering case-finding to 1,000 is likely to cost £70,000 Outcomes: number of additional people achieving a sustained response from treatment, life years gained (LYG), QALYsGeneral case:
CUA: £16,514/QALY
CEA: £20,084/QALY

Case-finding for hepatitis C is cost- effective in all sub-populations. It is likely to be more cost-effective if targeted at people whose hepatitis C disease is more advanced.
Discount rate: 6% for costs and 1.5% for health benefits

Probabilistic sensitivity analysis: at £30,000/QALY → 74% probability to be cost effective
At £20,000/ QALY→ 64% probability to be cost effective

Internal validity: 25/8/2
Fals-Stewart et al. 1997Intervention: BCT

Comparator: Individual-based treatment (IBT)
Patients: married or cohabiting substance- misuse males

Community

Data source of effect size measures and resource use:

RCT N = 80
IBT N= 40
BCT N = 40
Cost- effectiveness analysisCosts:

Direct costs: cost of providing treatment

BCT: Total cost = US$1,372.72
IBT: Total cost = US$1,359.94

Total cost of substance misuse- related healthcare

BCT Baseline: US$2,617.13
Follow-up: US$2,362.30

Criminal justice system utilisation costs

BCT Baseline: US$2,832.15
Follow-up: US$925.80
IBT: US$3,493.50
Follow-up: US$2,383.33
Each US$100 spent on BCT produced greater improvements for several indicators of treatment outcomes (ASI scales, % days of abstinent, consecutive days abstinent after treatment completion)Perspective: all service providing sectors

Currency: US dollars

Cost year: 1992

Discounting: not needed

Time horizon: 12 months

Internal validity: 19/10/6
Kraft et al., 1997 USInterventions

1st group: MMT with intensive counselling
2nd group: MMT plus enhanced counselling, medical, and psychosocial services

Comparator: MMT+ minimum counselling
Patients: methadone- maintained opioid users

Inpatient

Data source of effect size measures and resource use:

RCT: N = 100

Minimum methadone services: N = 31

MMT+ counselling: N = 36

MMT+ enhanced counselling, medical and psychosocial services: N = 33
Cost- effectiveness analysisCosts: physicians, nurse, counselling (psychological, individual drug, family, group, employment) methadone

Cost per person for the first 24 weeks of the programme

Minimum methadone services: US$2,471.09
MMT+counselling: US$2,315.33

Enhanced methadone services: US$3,414.03

Primary outcome:
Abstinence rates at 12 months’ follow-up

Minimum methadone services: 29%
Counselling +methadone services: 47%
Enhanced methadone services: 49%
Annual cost per abstinent client

Minimum methadone services: US$16,845
Counselling plus methadone services: US$9,804

Enhanced methadone services: US$11,818

ICER of minimum services versus counselling plus methadone services:

US$2,289 per additional abstinent client

ICER of counselling plus methadone services versus enhanced methadone services

US$22,410 per additional abstinent client
Perspective: all service providing sectors

Currency: US$

Discounting: not needed

Time horizon: 12 months

Internal validity: 19/9/8
Olmstead et al., 2007 USIntervention: Prize-based CM plus usual care

Comparator: Usual care of psychosocial substance misuse treatment
Patients who abuse stimulants

Community
Data source of effect size measures and resource use:

RCT: N = 415
CM: N = 209
Usual care: N = 206
Cost – effectiveness analysisCosts:

Direct costs: counselling, urine and breath sample testing (including the staff cost of administering these tests) and prize system (including the cost of administering the prize system)

Average cost per patient (mean, SD):
CM US$730 ($552)
SC US$292 ($217)
ΔC = US$ 438

Significant differences in costs between groups

Primary outcome: Longer duration of abstinence (LDA) during treatment (weeks)
CM 4.3 (4.6)
Usual care 2.6 (3.4)
Δ LDA = 1.7

Secondary outcomes Number of negative urines
CM 12.6 (9.0)
Usual care 9.6 (8.0)

Length of stay in study (LOS) (in weeks):
CM 8.1(4.2)
Usual care 7.0
Incremental cost of CM per additional week of LDA (95% CI): US$258 (US$191-401)

Incremental cost of CM per additional stimulant- negative urine samples (95% CI): US$146 (US$106-269)

Incremental cost of CM per additional 1 week extension the LOS in study (95% CI): US$398 (US$257-1074)
Sensitivity analysis based on three scenarios reflecting different assumptions Additional cost of extending LDA by 1 week US$163 (favourable scenario), US$229 (conservative scenario), US$269 (unfavourable scenario)

Additional cost of CM per additional negative urine test US$78 (favourable scenario), US$130 (conservative scenario), US$153 (unfavourable scenario)
Additional cost of extending LOS by 1 week US$163 (favourable scenario), US$354 (conservative scenario), US$416 (unfavourable scenario)

Perspective: all service providing sectors Currency: US$
Discounting: not needed

Time horizon: 12 weeks
Internal validity: 21/4/7
Paltiel et al., 2006Comparators: 1 day and increasingly frequent voluntary HIV screening of all adults using a same-day rapid testAdults (mean age 33 years) with unknown HIV status in US healthcare settings

US communities with 0.05–1.0% prevalence and annual incidence of 0.0084%–0.12%
Cost-utility analysisCosts:
Discounted lifetime HIV-related costs US$7,640/person

Outcomes: HIV infections averted, QALYs
US$30,800/QALY (one-time screening)
US$32,300/QALY (screening every 5 years)
US$55,500/QALY (screening every 3 years) for a population with 1.0% HIV prevalence

US$60,700/QALY if prevalence is 0.10%
Sensitivity analysis: multiway sensitivity analysis

Time horizon: Lifetime

Rapid HIV testing is cost effective in populations with a prevalence of 0.2% and above for undiagnosed HIV infection

Internal validity: 20/12/3
Perlman et al., 2001 USTreatment:
TB screening and on-site DOPT (directly observed preventive therapy): twice weekly to receive isoniazid (INH) 900 mg and pyridoxine 50 mg for 26 weeks

Comparator:
Treating active TB cases that would have occurred in the absence of an intervention
Active drug users with positive PPD (purified protein derivative) skin testing or with HIV infection and anergy were evaluated for clinical TB. On-site DOPT with twice weekly INH Syringe-exchange programme in NY, US

Study sample: N = 974
Cost- effectiveness analysisCosts: direct medical, staff fees, supplies, overhead, liver function tests, chest x-rays, INH preventive therapy, monetary incentives

TB infection total cost: US$10,144.90
TB disease total cost: US$17,850.16
INH total cost: US$118,747.36
Outcomes: TB cases averted over a 5-year follow-up under different adherence rates to chest X- ray completion and under a range of INH efficacy rates
TB screening and DOPT at a syringe exchange programme can be a cost-effective intervention for reducing TB among active drug users over a wide range of INH efficacy rates

5-year follow-up: US$25 incentive→
  1. increased chest X-ray adherence rate to 50% = US$170,054 net savings
  2. increased chest X-ray adherence rate to 100% = US$414,856
Sensitivity analysis: scenario testing

Monetary incentives to promote chest x- ray screening are justified if they have a positive impact on adherence

Discounting: not needed (healthcare inflation-discount rate)

17.5% of the study population were eligible for TB preventive therapy

Funded by NIDA (US)

Internal validity: 21/12/2
Sindelar et al. (2006) USInterventions

Standard treatment (STD) + low expected prize pay-out CM (US$80) STD+higher expected prize pay-out
Comparator: STD

Standard care
Patients: enrolled to outpatient treatment for cocaine abuse

Community

Data source of effect size measures and resource use:

RCT N = 120
Cost- effectiveness analysisCosts: Direct costs: counselling, testing, implementation of the prize draw procedure
STD: US$175.36
CM (US$80): US$276.12
CM (US$240): US$356.20

Outcomes:
Longest duration of consecutive abstinence (in weeks)
STD: 2.5
CM (US$80): 3.7
CM (US$240): 4.9

Percentage completing treatment
STD: 13.5%
CM (US$80): 20%
CM (US$240): 31.6%

Percentage of samples drug-free

STD: 62.3%
CM (US$80): 66.4%
CM (US$240): 82.2%
Incremental cost per ICER

Outcome: average consecutive weeks abstaining
ICER of US$80
CM versus STD: US$84.0
ICER of US$80
CM versus
US$240 CM: US$66.7
ICER of US$240
CM versus STD: US$75.4

Outcome: % completing 12 weeks
ICER of US$80
CM versus STD: US$15.5
ICER of US$80
CM versus US$240 CM: US$6.9
ICER of US$240
CM versus STD: $10.0

Outcome: % samples drug free ICER of US$80 CM versus STD: $24.6
ICER of US$80
CM versus US$240 CM: US$5.1
ICER of US$240
CM versus STD: US$9.1
Perspective: all service providing sectors

Currency: US$

Discounting: not needed

Time horizon: 12 weeks

Analysis is based on intention-to-treat

Internal validity: 21/4/7
Snyder et al., 1999 USTreatment: Isoniazid 300 mg and pyridoxine 50 mg daily with methadone dosage

INH therapy for 6–12 months

Comparator: Treating active TB cases that would have occurred in the absence of an intervention
Injecting drug users

HRTP project based in five methadone maintenance clinics in San Francisco, US

Study sample: N = 529
Cost- effectiveness analysisCosts: Were determined from the perspective of a local TB control programme, inpatient treatment US$(1998 prices)

Total average cost of programme: US$771,569
Net savings: US$104,660

Outcomes: completion rates of TB skin testing, medical evaluation, preventive therapy, number of active TB cases identified through screening
3-year follow-up of 20 cases (95%) averted 10-year follow-up of 30 TB cases (nearly 50%) averted plus 7.6 TB-related deaths

Net average savings per case prevented: US$3,724
Sensitivity analysis: scenario testing

Incentives and enablers to improve completion rates of medical evaluation and preventive therapy

Discounting: future costs and TB cases averted were discounted at a 3% rate

Internal validity: 21/9/4
Storer (2003) USInterventions Addiction medicine services (AMS)-brief interventions + standard care

Comparator: Standard care
Patients: hospitalised persons with substance use disorders

Inpatient

Data source of effect size measures and resource use:

Retrospective review of all patients admitted to Naval Medical Centre
Portsmouth in 2001:
N = 444
Brief interventions:
N = 186
No brief interventions:
N = 258
Cost-benefit analysisCosts:

Psychiatry:
Average cost of 1st admission US$12,410.93 ± US$52,91.19, (mean ± SD)
Average cost of 2nd admission US$17,834.31 ± US$24,903.62
Average cost of 3rd admission US$12,902.69 ± US$8,736.57

Internal medicine:
Average cost of 1st admission US$21,200.93 ± US$79,846.45
Average cost of 2nd admission US$23,690.78 ± US$28,787.04
Average cost of 3rd admission US$6,904.78 ± US$26,094.20

The unit cost of AMS-brief inter-ventions: US$153.70

Primary Outcome:

Readmission rates

With AMS-brief interventions:
Internal medicine: 15.4%
Psychiatry: 12%

Without AMS interventions:
Internal medicine: 40%
Psychiatry: 10.5%
Cost-benefit ratio: 19:1
Benefit per person: US$2,804.19

The total cost of preventable read- missions due to AMS: US$713,372.40
Perspective: all service providing sectors

Currency: US$

Cost year: 2001

Discounting: not needed

Time horizon: 12 months
Internal validity:
17/8/10
Copyright © 2008, The British Psychological Society & The Royal College of Psychiatrists.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.

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