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Economic evaluations of contingency management in illicit drug misuse programmes: A systematic review

James Shearer1, Hiong Tie, Sarah Byford

  • 1Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK.

Drug and Alcohol Review
|February 10, 2015
PubMed

Insights

Contingency management (CM) shows clinical effectiveness for opiate substitution therapy but lacks clear cost-effectiveness evidence. More research is needed to determine if CM is a viable option for national health systems.

Area of Science:

  • Health Economics
  • Addiction Treatment
  • Clinical Guidelines

Background:

  • UK clinical guidelines from 2007 recommended contingency management (CM) as an adjunct to opiate substitution therapy.
  • Despite documented clinical effectiveness, CM has not been widely adopted in the UK.
  • Evidence regarding the cost-effectiveness of CM is less clear, hindering its adoption by national health systems.

Purpose of the Study:

  • To systematically review and synthesize published economic evaluations of contingency management (CM).
  • To assess the cost-effectiveness of CM as an adjunct to opiate substitution therapy.
  • To identify gaps in the evidence base for CM's cost-effectiveness.

Main Methods:

  • Systematic review of published economic evaluations.
  • Descriptive synthesis of findings from identified studies.
  • Analysis of studies conducted in US treatment settings.

Main Results:

  • Nine economic evaluations were identified, primarily from US settings.
  • All studies indicated that CM increased both costs and effects (e.g., drug abstinence, medication adherence).
  • The existing evidence base has limited generalizability beyond specific research settings and populations.

Conclusions:

  • The current evidence on the cost-effectiveness of CM is insufficient for definitive conclusions.
  • More comprehensive and relevant evidence is required to support the adoption of CM by health systems.
  • Further research is needed to establish the cost-effectiveness of CM in diverse populations and settings.
Abstract

Keywords:
contingency managementeconomic evaluationreview

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