Cost-effectiveness of counselling as a treatment option for methamphetamine dependence

Abstract

Introduction and aims: Illicit methamphetamine (MA) use is an important public health concern. There is a dearth of knowledge about effective and cost-effective treatments for methamphetamine (MA) dependence in Australia. This article evaluates the cost-effectiveness of counselling as a treatment option for illicit MA use compared with no treatment option. Design and methods: Data are from 501 individuals recruited into Methamphetamine Treatment Evaluation Study (MATES). The population of MA users from MATES is extrapolated to a total number of 1000 MA users in the intervention group (counselling treatment) and control group (non-treatment group). A decision analytic model is developed that examines the costs and health outcomes [measures as quality adjusted life years (QALYs) gained] for the treatment and comparison group over a 3-year period. A societal perspective is adopted and model inputs are subject to sensitivity and uncertainty analysis to test the robustness of results to parameter variability. Results are discounted by using 3% discount rate and expressed in 2011 Australian dollars. Results: The incremental cost-effectiveness analysis suggests that counselling is a dominant health care intervention, i.e. saves money and is more effective than a do nothing intervention. The incremental difference in costs is -AU$18.36 million (95% CI -AU$22.80 million to -AU$14.31 million) and the incremental difference in QALY is 107 (95% CI -640 to 820) with a probability of 78.64% of counselling being a dominant and cost-effective treatment within the acceptable incremental cost-effectiveness ratio (ICER) of $63832 per QALY in the Australian society. The results of the sensitivity analysis show that the ICER is most sensitive to change in five major inputs: baseline utility, utility at 3 months, dealing crime costs, property crime costs and fraud crime costs. Discussion and Conclusions: The economic evaluation of the cost-effectiveness of counselling for MA dependence, as a first cost-effectiveness study to assess psychosocial treatment options for MA dependence, shows that greater investment in this cost-effective strategy will produce significant cost-savings and improve health outcomes as well as improve a lot of externality issues associated with drug use.