Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department.

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Abstract
Alcohol screening and brief intervention (SBI) has gained widespread acceptance as an effective method for reducing problem drinking in at-risk populations. This study examines the cost and cost-effectiveness of an SBI pilot program delivered in an inner-city hospital emergency department (ED) to a traditionally underserved population. A total of 1,036 subjects were screened for problem drinking during their visit to an ED. Eligible participants (N = 294) were randomly assigned to either a brief intervention group or a control group. As the result of attrition, a final sample of 194 (90 brief intervention; 104 control) participants remained at follow-up. The intervention consisted of a brief counseling session and a health information packet. The control group received only the packet. Intervention cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program. Selected outcomes at the 3-month follow-up included the raw Alcohol Use Disorders Identification Test score, average weekly number of drinks and engaging in heavy drinking in the past month (>6 drinks on one occasion for men, >4 for women). Outcome differences between the intervention and control groups were estimated with both bivariate and multivariate techniques. The average economic cost of the brief intervention was dollars 632 per subject, of which screening (dollars 497) was the largest component. In all cases, intervention subjects had better 3-month outcomes than control subjects, but the differences were not always statistically significant. Cost-effectiveness ratios were relatively small for all three outcomes, suggesting this type of intervention has the potential to be cost-effective under full implementation. The preliminary results demonstrate the potential advantage of further research in this area with larger samples and a longer follow-up period.

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