Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults

• First cost-effectiveness analysis of the Telephone Monitoring and Counseling intervention.
• The cost analysis includes both direct intervention costs as well as the costs incurred by patients.
• The CEA considers reduced societal costs of physical and mental health problems and crime.
• Results suggest TMC is a cost-effective and cost-saving strategy relative to treatment as usual.

IntroductionThe study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N = 108), or to one of two treatment conditions featuring TMC (N = 106) and TMC plus incentives (TMC-plus; N = 107). Follow-up assessments were conducted over a 2-year period.MethodsIntervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement.ResultsFrom the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake.ConclusionsTelephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness.Clinical trial registrationClinical Trials.gov Number: NCT00685659.