1. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.
- Author
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Rafia, Rachid, Dodd, Peter J., Brennan, Alan, Meier, Petra S., Hope, Vivian D., Ncube, Fortune, Byford, Sarah, Tie, Hiong, Metrebian, Nicola, Hellier, Jennifer, Weaver, Tim, and Strang, John
- Subjects
HEPATITIS B vaccines ,VACCINATION ,COST effectiveness ,CONTINGENCY theory (Management) ,TREATMENT of drug addiction ,ECONOMICS ,CONFIDENCE intervals ,DRUGS ,HEPATITIS B ,MEDICAL care costs ,MOTIVATION (Psychology) ,PATIENT compliance ,PROBABILITY theory ,RESEARCH funding ,REWARD (Psychology) ,INTRAVENOUS drug abusers ,RANDOMIZED controlled trials ,BEHAVIOR modification ,DISEASE incidence ,QUALITY-adjusted life years ,DESCRIPTIVE statistics - Abstract
Aims To determine whether the provision of contingencymanagement using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of healthcare resources. Design A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. Settings and participants Data on attendance to vaccination from a UK cluster randomized trial. Intervention Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. Measurement Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. Findings The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programmewas estimated to be £6738 (95% CI = £6297-7172),with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). Conclusions Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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