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.
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.
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DOI：
10.1177/26334895221089266
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发表时间：
2022-01
影响因子：
--
通讯作者：
Tueller, Stephen J.
中科院分区：
文献类型：
--
作者：
Hinde, Jesse M.;Garner, Bryan R.;Watson, Colleen J.;Ramanan, Rasika;Ball, Elizabeth L.;Tueller, Stephen J.
背景资料：作为药物滥用治疗艾滋病毒护理项目的一部分，实施和维持促进（ISF）战略被认为是一个有效的辅助成瘾技术转移中心（ATTC）的战略，整合一个动机性的访谈为基础的简短干预（MIBI）的物质使用障碍。本研究介绍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ATTC单独条件组和ATTC + ISF条件组。每个组织的两名工作人员接受了航空和技术培训中心的培训。在ATTC + ISF组织中，同样的两名工作人员和额外的支助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以及向客户交付409个MIBI所花费的时间的原始数据来估计成本。我们估计了工作人员水平的成本效益的MIBI交付的数量，平均MIBI质量分数，和总的客户日禁欲每名工作人员。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：调整后的每名工作人员成本为2，915美元的ATTC战略和5，371美元的ATTC + ISF，导致2，457美元的增量成本。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（ICER）。每名工作人员的禁欲天数增加了59天，质量调整生命年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战略的一个辅助手段，对于改善MIBI在艾滋病毒服务组织内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。差旅费占成本的近一半，虚拟实施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和建模选择影响我们如何解释对客户水平结果的影响。
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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影响因子：
1.8
作者：
Bray, Jeremy W.;Mallonee, Erin;Vendetti, Janice
通讯作者：
Vendetti, Janice
DOI：
10.1186/s12962-021-00278-4
发表时间：
2021-04-23
期刊：
Cost effectiveness and resource allocation : C/E
影响因子：
--
作者：
Nystrand C;Sampaio F;Hoch JS;Osman F;Feldman I
通讯作者：
Feldman I
影响因子：
4.4
作者：
Garner BR;Gotham HJ;Knudsen HK;Zulkiewicz BA;Tueller SJ;Berzofsky M;Donohoe T;Martin EG;Brown LL;Gordon T
通讯作者：
Gordon T
影响因子：
11.1
作者：
Marseille E;Larson B;Kazi DS;Kahn JG;Rosen S
通讯作者：
Rosen S
影响因子：
4.2
作者：
Azar, Marwan M.;Springer, Sandra A.;Meyer, Jaimie P.;Altice, Frederick L.
通讯作者：
Altice, Frederick L.