King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, UK.
Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, UK.
Value Health. 2023 May;26(5):658-665. doi: 10.1016/j.jval.2022.11.021. Epub 2022 Dec 9.
Cost-effectiveness analysis of two 12-week contingency management (CM) schedules targeting heroin abstinence or attendance at weekly keyworker appointments for opioid agonist treatment compared with treatment as usual (TAU).
A cost-effectiveness analysis was conducted alongside a cluster randomized trial of 552 patients from 34 clusters (drug treatment clinics) randomly allocated 1:1:1 to opioid agonist treatment plus weekly keyworker appointments with (1) CM targeted at heroin abstinence (CM abstinence), (2) CM targeted at on-time attendance at weekly appointments (CM attendance), or (3) no CM (TAU). The primary cost-effectiveness analysis at 24 weeks after randomization took a societal cost perspective with effects measured in heroin-negative urine samples.
At 24 weeks, mean differences in weekly heroin-negative urine results compared with TAU were 0.252 (95% confidence interval [CI] -0.397 to 0.901) for CM abstinence and 0.089 (95% CI -0.223 to 0.402) for CM attendance. Mean differences in costs were £2562 (95% CI £32-£5092) for CM abstinence and £317 (95% CI -£882 to £1518) for CM attendance. Incremental cost-effectiveness ratios were £10 167 per additional heroin-free urine for CM abstinence and £3562 for CM attendance with low probabilities of cost-effectiveness of 3.5% and 36%, respectively. Results were sensitive to timing of follow-up for CM attendance, which dominated TAU (better outcomes, lower costs) at 12 weeks, with an 88.4% probability of being cost-effective. Probability of cost-effectiveness remained low for CM abstinence (8.6%).
Financial incentives targeted toward heroin abstinence and treatment attendance were not cost-effective over the 24-week follow-up. Nevertheless, CM attendance was cost-effective over the treatment period (12 weeks), when participants were receiving keyworker appointments and incentives.
对两种为期 12 周的应急管理（CM）方案进行成本效益分析，这两种方案针对的是海洛因戒除或每周按时参加阿片类药物治疗的工作人员预约，与常规治疗（TAU）相比。
在一项针对 552 名患者的集群随机试验中，对来自 34 个集群（药物治疗诊所）的患者进行了一项成本效益分析，这些患者被随机分配为 1:1:1 至阿片类药物治疗加每周与工作人员预约，其中（1）CM 针对海洛因戒除（CM 戒除），（2）CM 针对按时参加每周预约（CM 出席），或（3）无 CM（TAU）。在随机分组后 24 周进行的主要成本效益分析采用了一种基于社会成本的观点，以尿样中不含海洛因的结果来衡量。
在 24 周时，与 TAU 相比，CM 戒除的每周尿样中不含海洛因的结果差异为 0.252（95%置信区间[CI] -0.397 至 0.901），CM 出席的结果差异为 0.089（95%CI -0.223 至 0.402）。CM 戒除的费用差异为 2562 英镑（95%CI 32 英镑至 5092 英镑），CM 出席的费用差异为 317 英镑（95%CI -882 英镑至 1518 英镑）。CM 戒除的增量成本效益比为每增加一个无海洛因尿样 10167 英镑，CM 出席的增量成本效益比为 3562 英镑，其成本效益的可能性分别为 3.5%和 36%。结果对 CM 出席的随访时间很敏感，CM 出席在 12 周时优于 TAU（更好的结果，更低的成本），有 88.4%的可能性具有成本效益。CM 戒除的成本效益仍然较低（8.6%）。
在 24 周的随访中，针对海洛因戒除和治疗出席的经济激励措施并不具有成本效益。然而，在接受工作人员预约和激励措施的治疗期间（12 周），CM 出席是具有成本效益的。
