An Economic Evaluation of Contingency Management for Completion of Hepatitis B Vaccination in Those on Treatment for Opiate Dependence

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 healthcare resources.

DESIGN:

A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and healthcare 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 randomised trial.

INTERVENTION:

Two contingency management options were examined in the trial: fixed vs. escalating schedule financial incentives.

MEASUREMENT:

Lifetime healthcare costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios.

FINDINGS:

The resulting estimate for the incremental lifetime healthcare cost of the contingency management strategy versus usual care was £22 (95% CI: -£12 to £40) per person offered the incentive. For 1,000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI: 8 to 30). The probabilistic incremental cost per quality adjusted life year gained of the contingency management programme was estimated to be £6,738 (95% CI: £6,297 to £7,172), with an 89% probability of being considered cost-effective at a threshold of £20,000 per quality-adjusted life years gained (98% 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 healthcare resources in the UK as long as the incidence remains above 1.2%.

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By:  Rafia R1, Dodd PJ1, Brennan A1, Meier PS2, Hope VD3, Ncube F3, Byford S4, Tie H4, Metrebian N5, Hellier J6, Weaver T7, Strang J5.

• 1Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield.
• 2Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield.
• 3Injecting Drug Use Team, HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE).
• 4Centre for the Economics of Mental and Physical Health, King's College London.
• 5National Addiction Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
• 6Department of Biostatistics, King's College London.
• 7Department of Mental Health, Social work and Integrative Medicine, Middlesex University. 
• Addiction. 2016 Mar 18. doi: 10.1111/add.13385. 

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