Olmstead Todd A, Sindelar Jody L, Easton Caroline J, Carroll Kathleen M
University of Connecticut Health Center, Department of Psychiatry, Farmington, CT 06030-1410, USA.
Addiction. 2007 Sep;102(9):1443-53. doi: 10.1111/j.1360-0443.2007.01909.x. Epub 2007 Jul 23.
To analyze data from a randomized clinical trial to determine the cost-effectiveness of using contingency management (CM) and motivational/skills building therapy (motivational enhancement therapy/cognitive-behavioral therapy: MET/CBT) to treat young adults with marijuana dependence. PARTICIPANTS, DESIGN AND MEASUREMENTS: A total of 136 marijuana-dependent young adults, all referred by the criminal justice system, were randomized to one of four treatment conditions: MET/CBT with CM, MET/CBT without CM, drug counseling (DC) with CM and DC without CM. Patient outcome measures include the longest duration of confirmed marijuana abstinence (LDA) during treatment and the total number of marijuana-free urine specimens provided during treatment. Costs were collected retrospectively from the provider and include the costs of therapy, patient drug testing, and those associated with the incentives component (value of vouchers, time to administer the voucher system).
Out-patient substance abuse clinic in New Haven, Connecticut, USA.
Which treatment is the most cost-effective depends on the threshold values of an additional week of LDA or an additional marijuana-free urine specimen. For example, the most effective treatment, MET/CBT with CM, was also the most cost-effective treatment at the highest threshold values, while the least effective treatment, DC, was the most cost-effective at the lowest values. Because consensus threshold values for these patient outcomes do not exist, results are presented showing the ranges of values over which each treatment would be considered cost-effective compared to the others. Acceptability curves are presented to show the decision uncertainty associated with these ranges. The results are shown to be robust to (i) sensitivity analyses on several key cost parameters and (ii) patient outcomes measured during the 6-month follow-up period.
This study uses incremental cost-effectiveness ratios and acceptability curves to shed light on the relative cost-effectiveness of four interventions for treating young adults with marijuana dependence. Given the relatively small and specialized nature of our study sample, and the fact that we examined a CM procedure with a single reinforcement schedule, additional studies are warranted to determine the reliability and generalizability of our results both to alternative marijuana-using populations and to CM procedures with alternative incentive parameters. Nevertheless, the relative durability of effects of MET/CBT compared to DC through the 6-month follow-up, and its cost-effectiveness over a comparatively wide range of threshold values, underscores the promise of this approach.
分析一项随机临床试验的数据，以确定采用应急管理（CM）和动机/技能培养疗法（动机增强疗法/认知行为疗法：MET/CBT）治疗大麻依赖的年轻成年人的成本效益。参与者、设计与测量：共有136名大麻依赖的年轻成年人，均由刑事司法系统转介而来，被随机分配到四种治疗条件之一：联合CM的MET/CBT、不联合CM的MET/CBT、联合CM的药物咨询（DC）以及不联合CM的DC。患者结局指标包括治疗期间确认的大麻戒断最长持续时间（LDA）以及治疗期间提供的无大麻尿液样本总数。成本是从提供者处回顾性收集的，包括治疗成本、患者药物检测成本以及与激励部分相关的成本（代金券价值、管理代金券系统的时间）。
美国康涅狄格州纽黑文的门诊药物滥用诊所。
哪种治疗最具成本效益取决于LDA额外增加一周或额外增加一个无大麻尿液样本的阈值。例如，最有效的治疗方法，即联合CM的MET/CBT，在最高阈值时也是最具成本效益的治疗方法，而最无效的治疗方法DC，在最低阈值时是最具成本效益的。由于不存在这些患者结局的共识阈值，因此呈现的结果显示了与其他治疗方法相比，每种治疗方法被认为具有成本效益的价值范围。给出了可接受性曲线以显示与这些范围相关的决策不确定性。结果显示对（i）几个关键成本参数的敏感性分析以及（ii）6个月随访期间测量的患者结局具有稳健性。
本研究使用增量成本效益比和可接受性曲线来阐明四种治疗大麻依赖年轻成年人的干预措施的相对成本效益。鉴于我们研究样本相对较小且具有特殊性，以及我们研究的是具有单一强化计划的CM程序这一事实，有必要进行更多研究以确定我们结果对其他大麻使用人群以及具有替代激励参数的CM程序的可靠性和普遍性。尽管如此，通过6个月随访，MET/CBT与DC相比效果的相对持久性，以及其在相对广泛的阈值范围内的成本效益突出了这种方法的前景。
