Cost-Effectiveness of In-Person vs. Virtual CM Training Approaches

SHARON LANG, BA
Brown University School of Public Health

Promotion of evidence-based practices (EBPs) often hinges upon training workshops designed to help counselors deliver EBPs with fidelity. The COVID-19 pandemic necessitated a rapid shift from in-person to virtual workshop training, yet the relative effectiveness and cost-effectiveness of these modalities is unknown. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) is an ongoing cluster-randomized hybrid type 3 trial examining strategies to implement contingency management (CM), a behavioral EBP, across opioid treatment programs. Counselors from the first cohort received in-person workshop training, whereas counselors from the second cohort received virtual workshop training. The shift to virtual training as a response to federal guidelines of social distancing presented a rare opportunity to compare the modalities. This study compared the effectiveness and cost-effectiveness of in-person and virtual training workshops for equipping opioid treatment program staff to implement contingency management.

The first cohort consisted of 26 counselors from eight opioid treatment programs, and the second cohort consisted of 31 counselors from 10 opioid treatment programs. All opioid treatment programs were located throughout the New England area, and the research study was based at Brown University in Rhode Island.

Counselors submitted post-training role-plays that were rated by independent coders for both readiness and proficiency to deliver CM. Per-clinician costs were estimated for the two modalities. Adjusted differences between cohorts were estimated using ordinary least squares, and an incremental cost effectiveness ratio was calculated to specify cost differences across cohorts.

Attainment rates of the readiness and proficiency benchmarks were higher in the virtual than in-person condition, though these differences were not statistically significant. Aggregated costs showed a $399 difference in per-clinician cost favoring virtual workshop training. Due to its lower cost and comparable effectiveness, the virtual modality was the dominant strategy.

Our findings support the utility and effectiveness of virtual workshop training and may inform the delivery of workshop training for other EBPs post-pandemic.