Actual and estimated replication costs for alcohol treatment modalities: case study from Project MATCH

Area of Science:

• Health economics
• Addiction treatment
• Clinical trial cost analysis

Background:

• Project MATCH evaluated three manual-guided, individually delivered alcohol treatments: Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), and Twelve-Step Facilitation (TSF).
• A comprehensive cost-effectiveness analysis requires understanding the relative costs of these treatments in both research and real-world clinical settings.

Purpose of the Study:

• To examine the relative costs of CBT, MET, and TSF as delivered in a randomized trial.
• To estimate the costs of replicating these three alcohol treatments in nonresearch clinical settings.

Main Methods:

• Costs were assessed for 12-session CBT, 4-session MET, and 12-session TSF over 12 weeks at two Project MATCH sites.
• Research cost calculations included clinical, administrative, and training/supervision variables.
• Investigators estimated replication costs for direct clinical expenses, administrative overhead, and training/supervision.

Main Results:

• In the research setting, MET had higher cost per contact hour ($498) than CBT ($198) and TSF ($253), but lower cost per participant ($1,700) than CBT ($1,901) and TSF ($1,969).
• For clinical replication, per-patient costs ranged from $512 (MET) to $750 (TSF) to $788 (CBT).
• MET demonstrated significant cost savings in replication: $238 (32%) less than TSF and $276 (35%) less than CBT.

Conclusions:

• Project MATCH treatments are expensive to produce within a clinical trial setting.
• Replicating these treatments in nonresearch clinical settings substantially reduces costs.
• MET appears to be the most cost-effective treatment for replication in nonresearch settings.