Addiction (Abingdon, England) · 2026
Cost-effectiveness of contingency management for methamphetamine use disorder: A model-based analysis.
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Qian Gary L, Chen Yupeng, Rawson Richard A, Humphreys Keith, Brandeau Margaret L
Аннотация
BACKGROUND AND AIMS: The United States (US) is experiencing a surge in methamphetamine use. Treatment options for methamphetamine use disorder (MethUD) focus on behavior change, particularly via contingency management (CM), where individuals receive rewards for submitting drug-free urine samples or for other positive behaviors such as attending treatment sessions. Little is known about the cost-effectiveness of CM for treating MethUD, including the January 2025 decision by the US federal government to increase the maximum annual CM incentive ten-fold to $750 per patient. This study aimed to assess the cost-effectiveness of CM for individuals with MethUD in the US.
DESIGN, SETTING AND PARTICIPANTS: We developed a microsimulation model of methamphetamine use behavior among individuals with MethUD to assess the effectiveness and cost-effectiveness of CM for treating MethUD. We modeled methamphetamine use states and psychiatric and cardiovascular comorbidities. We considered a 12-week and 24-week CM program, with a maximum $750 incentive. We simulated the model in weekly time steps over the lifetime of a cohort of 10 000 individuals with MethUD, under the status quo (no treatment) and with the CM program.
MEASUREMENTS: Number of deaths over one year and lifetime per person healthcare costs (healthcare sector perspective) and quality-adjusted life years (QALYs) experienced.
FINDINGS: With no treatment, 274 overdose deaths and 305 total deaths occurred in the cohort over 1 year. Individuals experienced 11.37 lifetime QALYs and incurred $216 320 in lifetime healthcare costs. With a 12-week CM program, an estimated 117 deaths were prevented over 1 year, with a net gain of 0.70 lifetime QALYs per person and incremental cost of $6850 compared with no treatment, yielding an incremental cost-effectiveness ratio (ICER) of $9830/QALY gained [95% credible interval (CR) = $8100-$11 400]. With a 24-week program, 153 deaths were prevented over 1 year, with a net gain of 0.81 lifetime QALYs per person and incremental cost of $10 000, yielding an ICER of $12 312/QALY gained (95% CR = $10 400-$14 100). Even under the pessimistic assumption of no lasting behavior change after CM program completion, the programs cost less than $130 000/QALY gained. Threshold analysis suggests that at a $50 000 willingness to pay, the 24-week program would be cost-effective even if the maximum incentive were $2491.
CONCLUSIONS: Modelling shows that contingency management appears to be a highly cost-effective intervention for treating methamphetamine use disorder, even with conservative assumptions and a $750 incentive cap. When cost impacts in the criminal justice and child welfare systems are included, such programs are likely cost-saving.
DESIGN, SETTING AND PARTICIPANTS: We developed a microsimulation model of methamphetamine use behavior among individuals with MethUD to assess the effectiveness and cost-effectiveness of CM for treating MethUD. We modeled methamphetamine use states and psychiatric and cardiovascular comorbidities. We considered a 12-week and 24-week CM program, with a maximum $750 incentive. We simulated the model in weekly time steps over the lifetime of a cohort of 10 000 individuals with MethUD, under the status quo (no treatment) and with the CM program.
MEASUREMENTS: Number of deaths over one year and lifetime per person healthcare costs (healthcare sector perspective) and quality-adjusted life years (QALYs) experienced.
FINDINGS: With no treatment, 274 overdose deaths and 305 total deaths occurred in the cohort over 1 year. Individuals experienced 11.37 lifetime QALYs and incurred $216 320 in lifetime healthcare costs. With a 12-week CM program, an estimated 117 deaths were prevented over 1 year, with a net gain of 0.70 lifetime QALYs per person and incremental cost of $6850 compared with no treatment, yielding an incremental cost-effectiveness ratio (ICER) of $9830/QALY gained [95% credible interval (CR) = $8100-$11 400]. With a 24-week program, 153 deaths were prevented over 1 year, with a net gain of 0.81 lifetime QALYs per person and incremental cost of $10 000, yielding an ICER of $12 312/QALY gained (95% CR = $10 400-$14 100). Even under the pessimistic assumption of no lasting behavior change after CM program completion, the programs cost less than $130 000/QALY gained. Threshold analysis suggests that at a $50 000 willingness to pay, the 24-week program would be cost-effective even if the maximum incentive were $2491.
CONCLUSIONS: Modelling shows that contingency management appears to be a highly cost-effective intervention for treating methamphetamine use disorder, even with conservative assumptions and a $750 incentive cap. When cost impacts in the criminal justice and child welfare systems are included, such programs are likely cost-saving.