Cost-effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a 4-year randomized trial

• Published in: Addiction (Abingdon, England) Vol. 108; no. 12; pp. 2166 - 2174
• Main Authors: McCollister, Kathryn E., French, Michael T., Freitas, Derek M., Dennis, Michael L., Scott, Christy K., Funk, Rodney R.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-12-2013; Blackwell
• Subjects: Abstinence; Addictive behaviors; Adult; Adult and adolescent clinical studies; African Americans - ethnology; Biological and medical sciences; Chicago; Chronic Disease; Chronic substance use disorder; Clinical trials; Cost analysis; Cost of Illness; Cost-Benefit Analysis; Cost-effectiveness; cost-effectiveness analysis; Data analysis; Drug addiction; economic evaluation; Experiments; Female; Humans; Illinois; Intervention; Long-Term Care - economics; Male; Males; Management; Medical sciences; Medical treatment; Miscellaneous; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recovery Management Checkups; Rehabilitation; Substance Abuse; Substance abuse treatment; Substance use; Substance-Related Disorders - economics; Substance-Related Disorders - ethnology; Substance-Related Disorders - rehabilitation; Treatment; Trials; U.S.A; Chicago; Human; Drug addiction; Chronic substance use disorder; Chronic disease; Recovery Management Checkups; Substance abuse; Management; cost-effectiveness analysis; Recovery; Chronic; Randomization; Addiction; Health economy; Adult; Clinical trial; Drug of abuse; economic evaluation; Cost analysis; Public health; Cost efficiency analysis
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.12335

Aims
This study performs the first cost‐effectiveness analysis (CEA) of Recovery Management Checkups (RMC) for adults with chronic substance use disorders.
Design
Cost‐effectiveness analysis of a randomized clinical trial of RMC. Participants were assigned randomly to a control condition of outcome monitoring (OM‐only) or the experimental condition OM‐plus‐RMC, with quarterly follow‐up for 4 years.
Setting
Participants were recruited from the largest central intake unit for substance abuse treatment in Chicago, Illinois, USA.
Participants
A total of 446 participants who were 38 years old on average, 54% male, and predominantly African American (85%).
Measurements
Data on the quarterly cost per participant come from a previous study of OM and RMC intervention costs. Effectiveness is measured as the number of days of abstinence and number of substance use‐related problems.
Findings
Over the 4‐year trial, OM‐plus‐RMC cost on average $2184 more than OM‐only (P < 0.01). Participants in OM‐plus‐RMC averaged 1026 days abstinent and had 89 substance use‐related problems. OM‐only averaged 932 days abstinent and reported 126 substance use‐related problems. Mean differences for both effectiveness measures were statistically significant (P < 0.01). The incremental cost‐effectiveness ratio for OM‐plus‐RMC was $23.38 per day abstinent and $59.51 per reduced substance‐related problem. When additional costs to society were factored into the analysis, OM‐plus‐RMC was less costly and more effective than OM‐only.
Conclusions
Recovery Management Checkups are a cost‐effective and potentially cost‐saving strategy for promoting abstinence and reducing substance use‐related problems among chronic substance users.