An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence

Rafia, R. et al. (2016) An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction, 111(9), pp. 1616-1627. (doi: 10.1111/add.13385) (PMID:26990598) (PMCID:PMC5347913)

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Aims: To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost‐effective use of health‐care 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 programme was 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%.

Item Type:Articles
Additional Information:This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference no. RP‐PG‐0707‐10 149).
Glasgow Author(s) Enlighten ID:Meier, Professor Petra
Authors: Rafia, R., Dodd, P. J., Brennan, A., Meier, P. S., Hope, V. D., Ncube, F., Byford, S., Tie, H., Metrebian, N., Hellier, J., Weaver, T., and Strang, J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Addiction
ISSN (Online):1360-0443
Published Online:06 May 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Addiction 111(9): 1616-1627
Publisher Policy:Reproduced under a Creative Commons License

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