Computerized Cognitive Behavioral Therapy for Alcohol Use Disorders vs. Traditional Therapy: Costs, Cost-Effectiveness, and Cost-Benefit from Multiple Perspectives

Alcohol use disorders (AUDs) cost the United States $249 billion in 2010 (Centers for Disease Control and Prevention, 2010). Costs are cited as barriers to providing and receiving evidence-based AUD treatment. Computer-based interventions may be a cost-effective and cost-beneficial way to increase access to such treatment. This study used pilot data (Kiluk et al., 2016) to compare the costs, efficacy, cost-effectiveness, and cost-benefit of three treatments for AUD outpatients: computer-based training for CBT plus treatment as usual (CBT4CBT + TAU), TAU alone, and CBT4CBT plus monitoring. Typical per patient costs were highest for CBT4CBT + TAU from all perspectives, followed by CBT4CBT + monitoring, and TAU. CBT4CBT + TAU cost significantly more than CBT4CBT + monitoring and TAU from patient and societal perspectives, but only more than CBT4CBT + monitoring from the provider perspective. Six-month changes in percentage of days alcohol abstinent were greater for CBT4CBT + TAU only when compared to CBT4CBT + monitoring. Cost-effectiveness ratios (CERs) determined the cost per additional day abstinent from the beginning of treatment through 1- and 6-month follow-ups. Neither CERs nor net benefits significantly differed between treatments at the follow-ups. Patient net benefits significantly outweighed patient costs at 1- and 6-month follow-up for the entire sample, for CBT4CBT + monitoring patients at 1-month follow-up, and CBT4CBT + TAU patients at 6-month follow-up.