Dr. McCollister is an Associate Professor and Health Economist in the Department Public Health Sciences at the University Of Miami Miller School Of Medicine. She is the Co-Director of the CHERISH Methodology Core.
This interview discusses her interest in substance use health economics and her most recent publication “Cost Effectiveness analysis of a continuing care intervention for cocaine dependent adults” in the journal Drug and Alcohol Dependence.
How did you come to be interested in substance use health economics? What motivates you about research in this field?
My interest in the economics of substance use disorders began when I was hired as a part-time senior research associate in the Health Economics Research Group at the University of Miami. I began working with Dr. Michael French, who had two NIH-funded R01 projects to conduct economic evaluations of treatment interventions for drug and alcohol abuse in adult and adolescent populations. This work provided me with a foundation in cost-effectiveness and cost-benefit analyses. Once I completed my PhD, I was hired as a faculty member in the Department of Public Health Sciences at UM and received funding from the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program as well as a K01 career development award from the National Institute on Drug Abuse to conduct economic evaluations of substance use treatment in criminal justice settings. This has proven to be an exciting field of research and I especially enjoy the interdisciplinary nature of this work.
Do you think this shift has translated to changes in how we study the economics of substance use treatment?
The current perspective on treating substance use disorders as a chronic disease has impacted how we approach economic studies of substance use treatment and related interventions. Continuing care approaches that provide step-down treatment options or recovery support services have proven to be clinically effective at reducing substance use relapse and are also cost-effective. When possible, economic studies of substance use interventions should incorporate longer analysis time frames to account for multiple episodes of treatment and other economic consequences that may demonstrate cost savings such as improved employment outcomes, reduced emergency department visits, or reduced criminal activity.
The study concluded that TMC is a cost-effective and cost saving strategy compared to treatment as usual from a payer and societal perspective. Several of the TMC intervention sessions were conducted over the phone. Do you think this presents an opportunity to provide continuing care in areas with few treatment resources? What are the minimum resources required to deliver the TMC intervention?
The TMC intervention was successfully carried out through phone and in-person counseling sessions. TMC clients were given a toll-free telephone number to call for their scheduled counseling appointments. Although this does still require counseling staff time, office space, telephone lines and support, overhead, and other standard operating costs for the treatment program, the telephone counseling option makes it easier for clients who may have transportation issues or other factors that would make it difficult to receive counseling services in person. I do think the TMC evaluation shows the potential for less resource-intensive treatment and/or recovery support services. In this regard, mobile phone applications addressing substance use problems may soon replace person-to-person calls.
We wanted to represent the payer and societal perspectives to support a policy-focused discussion of the cost-effectiveness results, as results from these two perspectives may not align. The payer perspective includes fewer costs (i.e., does not include client costs), and we wondered if this narrower examination of costs and effects would generate a significantly different result than the broader societal perspective where we included client costs as well as changes in societal costs associated with health problems and illegal activity. We found it interesting that, regardless of perspective, the cost effectiveness results supported the less expensive “TMC without client incentives,” and also that cost savings associated with the higher risk subgroup of clients that entered treatment using cocaine and/or other substances was greater in both the TMC and TMC-plus incentives experimental conditions.
To read Dr. McCollister’s paper: click here.