A cost-effectiveness analysis of modafinil therapy for psychostimulant dependence.

INTRODUCTION AND AIMS To examine the cost-effectiveness of modafinil (200 mg daily) plus counselling compared with placebo for the treatment of psychostimulant dependence. DESIGN AND METHODS Cost and outcome data were collected alongside two randomised controlled trials of modafinil 200 mg daily over 10 weeks for methamphetamine (n = 74) and cocaine dependence (n = 8), respectively. Incremental cost-effectiveness ratios representing the additional costs to achieve a given outcome were calculated for both the change in the number of stimulant-free days and quality-adjusted life years 12 weeks post-treatment. RESULTS The incremental cost-effectiveness ratio indicated that it would cost an additional $AUD79 to achieve an extra stimulant-free day with modafinil compared with placebo. This result was not statistically significant, but appeared to be a robust estimate after sensitivity analysis. Counselling, whether received within program or from other services, improved the cost-effectiveness of modafinil relative to placebo. DISCUSSION AND CONCLUSIONS Strategies to improve the uptake of counselling are recommended as cost-effective.

[1]  R. Mattick,et al.  A double-blind, placebo-controlled trial of modafinil (200 mg/day) for methamphetamine dependence. , 2009, Addiction.

[2]  Jason M. White,et al.  Symptoms and sleep patterns during inpatient treatment of methamphetamine withdrawal: a comparison of mirtazapine and modafinil with treatment as usual. , 2008, Journal of substance abuse treatment.

[3]  R. Mcketin,et al.  Impaired physical health among methamphetamine users in comparison with the general population: the role of methamphetamine dependence and opioid use. , 2008, Drug and alcohol review.

[4]  N. Lee,et al.  A systematic review of cognitive and behavioural therapies for methamphetamine dependence. , 2008, Drug and alcohol review.

[5]  J. Shearer.  The principles of agonist pharmacotherapy for psychostimulant dependence. , 2008, Drug and alcohol review.

[6]  F. Moeller,et al.  Levodopa pharmacotherapy for cocaine dependence: choosing the optimal behavioral therapy platform. , 2008, Drug and alcohol dependence.

[7]  M. Stitzer,et al.  Contingency Management: Utility in the Treatment of Drug Abuse Disorders , 2008, Clinical pharmacology and therapeutics.

[8]  David Lapsley.  The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05: summary version , 2008 .

[9]  S. Popova,et al.  The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. , 2007, Journal of studies on alcohol and drugs.

[10]  James Shearer,et al.  Contemporary cocaine use patterns and associated harms in Melbourne and Sydney, Australia. , 2007, Drug and alcohol review.

[11]  F. D. Del Boca,et al.  Enhancing the validity and utility of randomized clinical trials in addictions treatment research: III. Data processing and statistical analysis. , 2007, Addiction.

[12]  R. Mcketin,et al.  Methamphetamine and cardiovascular pathology: a review of the evidence. , 2007, Addiction.

[13]  J. Roll.  Contingency management: an evidence-based component of methamphetamine use disorder treatments. , 2007, Addiction.

[14]  D. Fatovich,et al.  Amphetamine‐related presentations to an inner‐city tertiary emergency department: a prospective evaluation , 2007, The Medical journal of Australia.

[15]  N. Petry,et al.  What do we get for our money? Cost-effectiveness of adding contingency management. , 2007, Addiction.

[16]  J. Russo,et al.  Methamphetamine Users in the Psychiatric Emergency Services: A Case-Control Study , 2007, The American journal of drug and alcohol abuse.

[17]  J. Shearer.  Psychosocial approaches to psychostimulant dependence: a systematic review. , 2007, Journal of substance abuse treatment.

[18]  J. Shearer,et al.  Cost effectiveness analysis of smoking cessation interventions , 2006, Australian and New Zealand journal of public health.

[19]  Wim van den Brink,et al.  Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population. , 2006, Drug and alcohol dependence.

[20]  S. Buchbinder,et al.  Risk factors for HIV infection among men who have sex with men , 2006, AIDS.

[21]  E. Curtis.  Meth mouth: a review of methamphetamine abuse and its oral manifestations. , 2006, General dentistry.

[22]  Bridget A. Martell,et al.  Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. , 2006, Archives of general psychiatry.

[23]  N. Heather,et al.  Effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT) , 2005, BMJ : British Medical Journal.

[24]  G. Davis,et al.  Cocaine and the heart , 2005, Postgraduate Medical Journal.

[25]  W. van den Brink,et al.  Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials , 2005, BMJ : British Medical Journal.

[26]  J. Rehm,et al.  Cost of addiction in Europe , 2005, European journal of neurology.

[27]  Nicole S. Kimmes,et al.  Etiology of xerostomia and dental caries among methamphetamine abusers. , 2005, Oral health & preventive dentistry.

[28]  K. Lynch,et al.  A Double-Blind, Placebo-Controlled Trial of Modafinil for Cocaine Dependence , 2005, Neuropsychopharmacology.

[29]  J. Shearer,et al.  Pharmacotherapies for problematic psychostimulant use: a review of current research. , 2004, Drug and alcohol review.

[30]  Andrew Briggs,et al.  Cost-effectiveness acceptability curves--facts, fallacies and frequently asked questions. , 2004, Health economics.

[31]  W. van den Brink,et al.  A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. , 2004, Drug and alcohol dependence.

[32]  M. Jofre-Bonet,et al.  Cost effectiveness of disulfiram: treating cocaine use in methadone-maintained patients. , 2004, Journal of substance abuse treatment.

[33]  Andrew Briggs,et al.  Missing... presumed at random: cost-analysis of incomplete data. , 2003, Health economics.

[34]  J. Schumacher,et al.  Costs and effectiveness of substance abuse treatments for homeless persons. , 2002, The journal of mental health policy and economics.

[35]  J. Brazier,et al.  The estimation of a preference-based measure of health from the SF-36. , 2002, Journal of health economics.

[36]  N. Zethraeus,et al.  Definition, interpretation and calculation of cost-effectiveness acceptability curves. , 2000, Health economics.

[37]  A H Briggs,et al.  Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. , 1997, Health economics.

[38]  D Polsky,et al.  Confidence intervals for cost-effectiveness ratios: a comparison of four methods. , 1997, Health economics.

[39]  R. Brooks.  EuroQol: the current state of play. , 1996, Health policy.

[40]  R. Chaisson,et al.  Cocaine use and HIV infection in intravenous drug users in San Francisco. , 1989, JAMA.