The implementation & sustainment facilitation (ISF) strategy: Cost and cost-effectiveness results from a 39-site cluster randomized trial integrating substance use services in community-based HIV service organizations.

Jesse M Hinde, Bryan R Garner, Colleen J Watson, Rasika Ramanan, Elizabeth L Ball, Stephen J Tueller
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引用次数: 2

Abstract

Background: As part of the Substance Abuse Treatment to HIV Care Project, the Implementation & Sustainment Facilitation (ISF) strategy was found to be an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for substance use disorders. This study presents the cost and cost-effectiveness results. Methods: Thirty-nine HIV service organizations were randomized to receive the ATTC-only condition or the ATTC + ISF condition. Two staff from each organization received the ATTC-training. In ATTC + ISF organizations, the same two staff and additional support staff participated in facilitation sessions to support MIBI implementation. We estimated costs using primary data on the time spent in each strategy and the time spent delivering 409 MIBIs to clients. We estimated staff-level cost-effectiveness for the number of MIBIs delivered, average MIBI quality scores, and total client days abstinent per staff. We used sensitivity analyses to test how changes to key variables affect the results. Results: Adjusted per-staff costs were $2,915 for the ATTC strategy and $5,371 for ATTC + ISF, resulting in an incremental cost of $2,457. ATTC + ISF significantly increased the number of MIBIs delivered (3.73) and the average MIBI quality score (61.45), yielding incremental cost effectiveness ratios (ICERs) of $659 and $40. Client days abstinent increased by 59 days per staff with a quality-adjusted life-year ICER of $40,578 (95% confidence interval $29,795-$61,031). Conclusions: From the perspective of federal policymakers, ISF as an adjunct to the ATTC strategy may be cost-effective for improving the integration of MIBIs within HIV service organizations, especially if scaled up to reach more clients. Travel accounted for nearly half of costs, and virtual implementation may further increase value. We also highlight two considerations for cost-effectiveness analysis with hybrid trials: study protocols kept recruitment low and modeling choices affect how we interpret the effects on client-level outcomes.

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实施和维持促进(ISF)战略:39个站点的集群随机试验的成本和成本效益结果,该试验整合了社区艾滋病毒服务组织的药物使用服务。
背景:作为药物滥用治疗HIV护理项目的一部分,实施和维持促进(ISF)策略被发现是成瘾技术转移中心(ATTC)策略的有效辅助,用于整合基于动机访谈的药物使用障碍简短干预(MIBI)。本研究提出了成本和成本效益的结果。方法:将39家HIV服务机构随机分为单纯ATTC组和ATTC + ISF组。每个组织的两名工作人员接受了atc培训。在atc + ISF组织中,同样的两名工作人员和额外的支持人员参加了促进会议,以支持MIBI的实施。我们使用每个策略所花费的时间和向客户交付409个mibi所花费的时间的原始数据来估算成本。我们估计了员工层面的成本效益,包括交付的MIBI数量、平均MIBI质量分数和每个员工的总客户天数。我们使用敏感性分析来测试关键变量的变化如何影响结果。结果:调整后的人员人均成本为ATTC战略为2,915美元,ATTC + ISF为5,371美元,导致增量成本为2,457美元。ATTC + ISF显著增加了交付的MIBI数量(3.73)和平均MIBI质量评分(61.45),产生了659美元和40美元的增量成本效益比(ICERs)。每位员工的客户戒断天数增加了59天,质量调整后的生命年ICER为40,578美元(95%置信区间为29,795- 61,031美元)。结论:从联邦政策制定者的角度来看,ISF作为ATTC战略的一种辅助手段,对于改善HIV服务组织内mibi的整合可能具有成本效益,特别是如果扩大规模以覆盖更多的客户。差旅占了近一半的成本,而虚拟实现可能会进一步增加价值。我们还强调了混合试验成本效益分析的两个考虑因素:研究方案保持低招募率,建模选择影响我们如何解释对客户水平结果的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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