Cost-effectiveness of a Motivational Intervention for Alcohol-involved Youth in a Hospital Emergency Department

Overview

Journal J Stud Alcohol Drugs

Specialty Psychiatry

Date 2010 Apr 23

PMID 20409432

Citations 33

Authors

Charles J Neighbors

Nancy P Barnett

Damaris J Rohsenow

Suzanne M Colby

Peter M Monti

Affiliations

Soon will be listed here.

Abstract

Objective: Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained.

Method: Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases.

Results: Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates.

Conclusions: This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

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References

Monti P, Colby S, Barnett N, Spirito A, Rohsenow D, Myers M . Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. J Consult Clin Psychol. 1999; 67(6):989-94. DOI: 10.1037//0022-006x.67.6.989. View

Monti P, Barnett N, Colby S, Gwaltney C, Spirito A, Rohsenow D . Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction. 2007; 102(8):1234-43. DOI: 10.1111/j.1360-0443.2007.01878.x. View

Zador P, Krawchuk S, Voas R . Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data. J Stud Alcohol. 2000; 61(3):387-95. DOI: 10.15288/jsa.2000.61.387. View

Erickson P . Evaluation of a population-based measure of quality of life: the Health and Activity Limitation Index (HALex). Qual Life Res. 1998; 7(2):101-14. DOI: 10.1023/a:1008897107977. View

Maio R, Portnoy J, Blow F, Hill E . Injury type, injury severity, and repeat occurrence of alcohol-related trauma in adolescents. Alcohol Clin Exp Res. 1994; 18(2):261-4. DOI: 10.1111/j.1530-0277.1994.tb00011.x. View

Coyle D, Lee K . The problem of protocol driven costs in pharmacoeconomic analysis. Pharmacoeconomics. 1999; 14(4):357-63. DOI: 10.2165/00019053-199814040-00003. View

Jelalian E, Spirito A, Rasile D, VINNICK L, Rohrbeck C, Arrigan M . Risk taking, reported injury, and perception of future injury among adolescents. J Pediatr Psychol. 1997; 22(4):513-31. DOI: 10.1093/jpepsy/22.4.513. View

Fleming M, Mundt M, French M, Manwell L, Stauffacher E, Barry K . Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Med Care. 2000; 38(1):7-18. DOI: 10.1097/00005650-200001000-00003. View

Danseco E, Miller T, Spicer R . Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. Pediatrics. 2000; 105(2):E27. DOI: 10.1542/peds.105.2.e27. View

10.

Bauman A, Phongsavan P . Epidemiology of substance use in adolescence: prevalence, trends and policy implications. Drug Alcohol Depend. 1999; 55(3):187-207. DOI: 10.1016/s0376-8716(99)00016-2. View

11.

Miller T, Lestina D, Spicer R . Highway crash costs in the United States by driver age, blood alcohol level, victim age, and restraint use. Accid Anal Prev. 1998; 30(2):137-50. DOI: 10.1016/s0001-4575(97)00093-6. View

12.

Longabaugh R, Woolard R, Nirenberg T, Minugh A, Becker B, Clifford P . Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. J Stud Alcohol. 2002; 62(6):806-16. DOI: 10.15288/jsa.2001.62.806. View

13.

Donovan J . Young adult drinking-driving: behavioral and psychosocial correlates. J Stud Alcohol. 1993; 54(5):600-13. DOI: 10.15288/jsa.1993.54.600. View

14.

Doubilet P, Begg C, Weinstein M, Braun P, McNeil B . Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 1985; 5(2):157-77. DOI: 10.1177/0272989X8500500205. View

15.

McDonald 3rd A, Wang N, Camargo Jr C . US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Arch Intern Med. 2004; 164(5):531-7. DOI: 10.1001/archinte.164.5.531. View

16.

Williams R . The costs of visits to emergency departments. N Engl J Med. 1996; 334(10):642-6. DOI: 10.1056/NEJM199603073341007. View

17.

Helmkamp J, Hungerford D, Williams J, Manley W, Furbee P, Horn K . Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department. J Am Coll Health. 2004; 52(1):7-16. DOI: 10.1080/07448480309595718. View

18.

Hungerford D, Pollock D . Emergency department services for patients with alcohol problems: research directions. Acad Emerg Med. 2003; 10(1):79-84. DOI: 10.1111/j.1553-2712.2003.tb01982.x. View

19.

Gentilello L, Ebel B, Wickizer T, Salkever D, Rivara F . Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005; 241(4):541-50. PMC: 1357055. DOI: 10.1097/01.sla.0000157133.80396.1c. View

20.

Gentilello L, Rivara F, Donovan D, Jurkovich G, Daranciang E, Dunn C . Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999; 230(4):473-80; discussion 480-3. PMC: 1420896. DOI: 10.1097/00000658-199910000-00003. View