Cost-effectiveness of telephone counseling and relapse prevention for cocaine or alcohol dependent clients Donald S Shepard1 Aaron Beaston-Blaakman2 James McKay3 1 Brandeis University, Schneider Institute for Health Policy, Waltham, MA 2 Family

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Cost-effectiveness of telephone counseling and
relapse prevention for cocaine or alcohol
dependent clients Donald S Shepard1Aaron
Beaston-Blaakman2 James McKay31 Brandeis
University, Schneider Institute for Health
Policy, Waltham, MA2 Family Health
International, Research Triangle Park, NC3
University of Pennsylvania, Philadelphia, PA

• Oct. 24-26, 2005
• Shepard_at_Brandeis.edu
• Tel [phone]
• Brandeis University, Waltham MA 02454

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Introduction Cost-Effectiveness Analysis (CEA)

• Cost-effectiveness analyses (CEA) seek to help
  programs and payers allocate shrinking resources
  for substance abuse treatment most effectively.

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Methods Design

• Random assignment study
• Each approach entailed 1-2 counseling initial
  contacts per week
• Each intervention lasted 12 weeks
• Quarterly research follow-up over 2 years

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Methods Subjects

• 359 Philadelphia adult alcohol or cocaine
  dependent clients
• Had just completed intensive outpatient treatment.

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Methods Interventions

• Standard care (standard group continuing care,
  STND) was the reference against which the two
  newer approaches to continuing care were
  compared.
• Relapse prevention emphasized individual
  in-person sessions (RP)
• Telephone counseling (TEL) delivered most
  sessions by phone with the fewest minutes of
  therapeutic contact.

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Methods Costs

• Program costs were assessed with a preliminary
  version of the Treatment Cost Analysis Tool
  (TCAT).
• Following recommended CE guidelines, societal
  costs were also included.
• Clients travel expenses averaged 2.75 per round
  trip (bulk tickets on Philadelphia public
  transport)
• Clients time in treatment, waiting, and travel
  were valued at Pennsylvania minimum wage
  (5.65/hr)

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Comparative intensity of interventions
Average number per client over intervention Standard Aftercare (STND, Reference) Relapse Prevention (RP) Tele-phone (TEL)
Planned contacts with counselor 24 24 13.5
Individual Sessions 0 12 1
Group Sessions 24 12 4
Telephone Contacts 0 0 8.5
Counselor contact hours 4 14 5
Client time (hours) 48 72 23.3
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Average costs of interventions per client
Measure Standard Aftercare (STND) Relapse Prevention (RP) Telephone (TEL)
Program cost 341 1,192 426
Value of client time 271 407 132
Client travel expense 66 66 14
Societal cost 678 1,665 571
Incremental program cost n.a. 852 85
Incremental societal cost n.a. 987 -106
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Results Effectiveness
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Results Cost-Effectiveness
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Results Cost per incremental abstinent year
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Discussion Program cost comparison
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Discussion Societal cost comparison
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Results Cost-Effectiveness

• In terms of program costs only, TEL was most
  cost-effective
• In overall cost per client, moreover, TEL, which
  minimized client time, was least expensive
  (571), STND was intermediate (678), while RP
  remained most costly (1665).

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Conclusions

• TEL was economically superior to (i.e.,
  dominated) the other approaches in generating
  better outcomes with less total resources.
• Telephone-based counseling appears to be a highly
  cost-effective approach to continuing care
  (aftercare) in alcohol and cocaine dependent
  patients.

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