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

OBJECTIVE: As a first step in a thorough cost-effectiveness analysis of a randomized alcohol-treatment-matching trial (Project MATCH), the present study examines the relative costs of three manual-guided, individually delivered treatments and the costs of replicating them in nonresearch settings. METHOD: Costs of delivering a 12-session Cognitive Behavioral Therapy (CBT), a 4-session Motivational Enhancement Therapy (MET) and a 12- session Twelve-Step Facilitation (TSF) treatment over 12 weeks were assessed for three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI, and Providence, RI). Research cost calculations included clinical, administrative and training/supervision variables in determining total treatment costs, average cost per contact hour and average cost per research participant. Investigators from all nine MATCH locations estimated direct clinical costs, administrative overhead costs and training/supervision costs for replicating these treatments. RESULTS: For Project MATCH, MET cost twice as much or more per patient contact hour (mean = $498) than CBT (mean = $198) and TSF (mean = $253) but was less costly per research participant (mean = $1,700) than both CBT (mean = $1,901) and TSF (mean = $1,969). For clinical replication, high end per patient costs ranged from $512 for MET to $750 for TSF to $788 for CBT: a cost savings for MET of $238 (32%) over TSF and $276 (35%) over CBT. CONCLUSIONS: As part of a randomized clinical trial, MATCH treatments are costly to produce. However, when estimates are used to project these costs to nonresearch clinical settings, the costs are greatly reduced. Whereas MET appears to be much less costly to deliver in nonresearch settings than the other two treatments, the estimated cost differentials are less than the 1:3 treatment session ratio for MET versus TSF or CBT.