Economic evaluations of contingency management in illicit drug misuse programmes: A systematic review

IssuesUK clinical guidelines published in 2007 recommended contingency management (CM) as an adjunct to opiate substitution therapy. However, CM has not been adopted in the UK despite evidence of clinical effectiveness. Evidence for the cost-effectiveness of CM is less clear and will need to be explored if CM is to be adopted by national health systems in countries such as the UK. ApproachSystematic review and descriptive synthesis of published economic evaluations. Key FindingsThe review identified nine published studies that could be classified as economic evaluations. These were all based within US treatment settings, and five were conducted by the same group of authors. All studies found that the addition of CM to usual care increased both costs and effects (commonly drug abstinence or medication adherence). ImplicationsThis review confirms that the existing evidence base for cost-effectiveness has limited generalisability beyond the original research clinical settings and populations. ConclusionThe data were not sufficiently strong to make any conclusion about the cost-effectiveness of CM. More relevant and comprehensive evidence for cost-effectiveness than currently exists is needed.