Cost-Effectiveness of Peer-Delivered Interventions for Cocaine and Alcohol Abuse among Women: A Randomized Controlled Trial

<div><h3>Aims</h3><p>To determine whether the additional interventions to standard care are cost-effective in addressing cocaine and alcohol abuse at 4 months (4 M) and 12 months (12 M) from baseline.</p> <h3>Method</h3><p>We conducted a cost-effectiveness analysis of a randomized controlled trial with three arms: (1) NIDA's Standard intervention (SI); (2) SI plus a Well Woman Exam (WWE); and, (3) SI, WWE, plus four Educational Sessions (4ES).</p> <h3>Results</h3><p>To obtain an additional cocaine abstainer, WWE compared to SI cost $7,223 at 4 M and$3,611 at 12 M. Per additional alcohol abstainer, WWE compared to SI cost $3,611 and$7,223 at 4 M and 12 M, respectively. At 12 M, 4ES was dominated (more costly and less effective) by WWE for abstinence outcomes.</p> <h3>Conclusions</h3><p>To our knowledge, this is the first cost-effectiveness analysis simultaneously examining cocaine and alcohol abuse in women. Depending on primary outcomes sought and priorities of policy makers, peer-delivered interventions can be a cost-effective way to address the needs of this growing, underserved population.</p> <h3>Trial Registration</h3><p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01235091">NCT01235091</a></p> </div

One-Way Sensitivity Analyses of Clinically Significant Outcomes.

<p>Abbreviations: ICER, incremental cost effectiveness ratio, which is the difference in cost divided by the difference in effectiveness as compared with the next least costly intervention and indicates cost per additional outcome achieved; A, SI intervention; B, WWE intervention; C, 4ES intervention.</p>a<p>Indicates the outcome achieved in the analysis.</p>b<p>Occasions = days used * times per day.</p

Two-way Sensitivity Analyses on Cost and Effectiveness.

<p>Two-way Sensitivity Analyses on Cost and Effectiveness.</p

Incremental Cost-Effectiveness Analyses: Cocaine Outcomes^a.

<p>Abbreviations: SI, NIDA's Standard Intervention; WWE, SI plus Well Woman Exam; 4ES, SI, WWE plus four educational sessions; ICER, incremental cost effectiveness ratio, which is the difference in cost divided by the difference in effectiveness as compared with the next least costly intervention, and indicates cost per additional outcome achieved; BL, baseline; D, dominated, which indicates that the intervention is more costly and less effective than the alternative; ED, extended dominated, which indicates that the next alternative is more costly, more effective and has a better ICER.</p>a<p>Costs from Ruger et al., 2010. Due to rounding, calculations may not exactly reflect data from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033594#pone-0033594-t002" target="_blank">Table 2</a>. ICERs did not need to be adjusted because the intervention has a sufficiently long follow up time period.</p>b<p>Positive number indicates incremental improvement. Each value is the difference of the differences from <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0033594#pone-0033594-t002" target="_blank">Table 2</a>.</p>c<p>Number of occasions used cocaine, past 30 days (number of days used * times per day).</p>d<p>Number of episodes used cocaine per day, past 30 days.</p>e<p>Number of cocaine free days, past 30 days.</p>f<p>Proportion of participants abstaining from cocaine, past 30 days.</p>g<p>Proportion of participants abstaining from cocaine, past 4 months.</p>h<p>Past 30 days.</p>i<p>Per day, past 30 days.</p