Carolina Barbosa1, Alexander Cowell2, Jeremy Bray3, Arnie Aldridge2. 1. RTI International, 230 West Monroe St., Suite 2100, Chicago, IL, USA 60606-4901. Electronic address: cbarbosa@rti.org. 2. RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709. 3. Bryan School of Business and Economics, 462 Bryan Building, P.O. Box 26170, UNC Greensboro, Greensboro, NC 27402-6170.
Abstract
OBJECTIVE: This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings. METHODS: A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed. RESULTS: When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained. CONCLUSIONS: Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient.
OBJECTIVE: This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings. METHODS: A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed. RESULTS: When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained. CONCLUSIONS:Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient.
Authors: Traci Rieckmann; Stephanie Renfro; Dennis McCarty; Robin Baker; K John McConnell Journal: Health Serv Res Date: 2017-05-31 Impact factor: 3.402
Authors: Stephanie M Mathis; Nicholas Hagemeier; Angela Hagaman; John Dreyzehner; Robert P Pack Journal: Curr HIV/AIDS Rep Date: 2018-10 Impact factor: 5.071
Authors: Kristin L Serowik; Kimberly A Yonkers; Kathryn Gilstad-Hayden; Ariadna Forray; Paula Zimbrean; Steve Martino Journal: J Gen Intern Med Date: 2020-10-27 Impact factor: 5.128