RTI International, Research Triangle Park, NC, United States.
RTI International, Research Triangle Park, NC, United States.
Drug Alcohol Depend. 2023 Mar 1;244:109754. doi: 10.1016/j.drugalcdep.2022.109754. Epub 2022 Dec 23.
Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care.
To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment.
ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915.
ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.
物质使用障碍与失业和贫困有关。然而，很少有干预措施旨在改善物质使用、失业，以及更遥远的贫困问题。有条件禁欲工资补贴（ACWS）随机对照试验将治疗性工作场所与有条件禁欲工资补贴相结合，以解决物质使用和失业问题。ACWS 研究发现，有条件禁欲工资补贴增加了药物检测呈阴性、就业和收入超过贫困线的参与者的比例，在干预期间。本研究介绍了 ACWS 的成本，并计算了 ACWS 与常规护理相比的成本效益。
为了计算 ACWS 的成本和成本效益，我们使用基于活动的成本核算方法来计算干预的成本，并从提供者和医疗保健部门的角度计算成本。我们计算了阴性药物测试和就业的增量成本效益比和成本效益可接受性曲线。
ACWS 在 12 个月的干预期间，每位参与者的成本为 11310 美元。在干预期间，每位参与者的总干预和医疗保健成本为常规护理的 20625 美元和 ACWS 的 30686 美元。在干预期末，额外的阴性药物测试参与者的成本为 1437 美元，而额外的就业参与者的成本为 915 美元。
ACWS 增加了药物戒断和就业，并且如果决策者愿意支付与干预相关的增量成本，那么在 12 个月的干预期末可能具有成本效益。
