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

Rafia, Rachid, Dodd, Peter J., Brennan, Alan, Meier, Petra S., Hope, Vivian D., Ncube, Fortune, Byford, Sarah, Tie, Hiong, Metrebian, Nicola, Hellier, Jennifer, Weaver, Tim ORCID: https://orcid.org/0000-0002-3437-3556 and Strang, John (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. ISSN 0965-2140 (doi:10.1111/add.13385)

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Abstract

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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