This multisite pragmatic randomized clinical trial evaluated the costs and cost-effectiveness of brief telephone-delivered motivational interviewing to engage veterans in pain and substance use treatment. The intervention, referred to as MAPS (motivational interviewing for pain activation), aimed to increase treatment engagement for service-related musculoskeletal conditions and to assess whether the intervention produced value compared with usual care over a 36-week follow-up.
The study was a two-arm, parallel-group randomized pragmatic clinical trial conducted across eight US Department of Veterans Affairs medical centers in six states in the New England region. Assessment staff were blinded to treatment group assignment. Cost data were derived from VA administrative databases and participant questionnaires. The analysis reported here focuses on economic and quality-of-life secondary outcomes for the MAPS intervention versus usual care.
Veterans who had a New England address and had filed a claim for a service-related musculoskeletal injury were invited if they reported at least moderately severe pain and could be reached by telephone. Exclusion criteria included current enrollment in another trial, receipt of more than two types of VA pain services in the preceding 12 weeks, or unavailability for follow-up. A total of 1,101 participants were enrolled; cost-effectiveness analyses included 945 participants (85.8%) who had at least one follow-up assessment.
The MAPS intervention consisted of a single 1-hour telephone-delivered motivational interview designed to engage participants in treatment, followed by up to four 20-minute follow-up telephone sessions. The reported intervention cost was US$300 per participant. Usual care participants continued to receive standard VA services without the MAPS contacts.
Costs were assessed using a combination of VA administrative data and participant questionnaires. The study reported costs from both a healthcare system perspective (VA costs for musculoskeletal care) and a broader societal perspective. The societal perspective was assessed but the study found no significant difference in total societal cost between the intervention and usual care groups over the trial period.
The trial’s primary outcomes were change in pain intensity and substance use. This report focuses on secondary outcomes: cost-effectiveness and preference-rated quality of life, along with healthcare utilization and activity limitations. Pain intensity and quality-of-life measures were collected during follow-up assessments blinded to treatment assignment.
Participants randomized to MAPS had significantly greater use of several musculoskeletal care modalities, including physical therapy, spinal manipulation, acupuncture and other outpatient visits. From the healthcare system perspective, the MAPS arm incurred greater musculoskeletal care costs, with an average increase of US$1,508 per participant compared with usual care over the 36-week follow-up. From the societal perspective, the study reported no significant difference in total costs between arms.
MAPS produced a slight reduction in pain intensity over the 36-week trial period. However, the intervention did not result in a significant improvement in preference-rated quality of life. Activity limitations were assessed in the trial but specific numeric effect sizes and statistical details beyond the summary statements in the source extract are not reported here.
Over the 36-week time horizon of the trial, MAPS was not cost-effective. The intervention increased use of musculoskeletal services and raised healthcare system costs while producing only a small reduction in pain and no measurable gain in preference-rated quality of life during the study window. The authors note that long-term cost-effectiveness beyond the trial’s 36 weeks remains unknown.
The source extract contains truncation of one sentence reporting an increase in cost (the p value and some accompanying detail were cut off); those specific statistical details are not available in the provided text and therefore are not reported here. Additional limitations that would normally inform economic interpretation—such as detailed breakdowns of cost components, confidence intervals for incremental cost-effectiveness ratios, or sensitivity analyses—were not included in this extract and thus are not summarized.
Overall, in this veteran population seeking compensation for service-related musculoskeletal injury, brief telephone-delivered motivational interviewing (MAPS) increased engagement with musculoskeletal services and increased short-term healthcare costs without demonstrating short-term cost-effectiveness on the 36-week horizon.