Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings.
BACKGROUND
Few studies have estimated the economic costs and benefits of brief physician advice in managed care settings.


OBJECTIVE
To conduct a benefit-cost analysis of brief physician advice regarding problem drinking.


METHODS
Patient and health care costs associated with brief advice were compared with economic benefits associated with changes in health care utilization, legal events, and motor vehicle accidents using 6- and 12-month follow-up data from Project TrEAT (Trial for Early Alcohol Treatment), a randomized controlled clinical trial.


METHODS
482 men and 292 women who reported drinking above a threshold limit were randomized into control (n = 382) or intervention (n = 392) groups.


METHODS
Outcomes included alcohol use, emergency department visits, hospital days, legal events, and motor vehicle accidents.


RESULTS
No significant differences between control and intervention subjects were present for baseline alcohol use, age, socioeconomic status, smoking, depression or anxiety, conduct disorders, drug use, crimes, motor vehicle accidents, or health care utilization. The total economic benefit of the brief intervention was $423,519 (95% CI: $35,947, $884,848), composed of $195,448 (95% CI: $36,734, $389,160) in savings in emergency department and hospital use and $228,071 (95% CI: -$191,419, $757,303) in avoided costs of crime and motor vehicle accidents. The average (per subject) benefit was $1,151 (95% CI: $92, $2,257). The estimated total economic cost of the intervention was $80,210, or $205 per subject. The benefit-cost ratio was 5.6:1 (95% CI: 0.4, 11.0), or $56,263 in total benefit for every $10,000 invested.


CONCLUSIONS
These results offer the first quantitative evidence that implementation of a brief intervention for problem drinkers can generate positive net benefit for patients, the health care system, and society.
Fleming
M F
MF
Center for Addiction Research and Education, University of Wisconsin, Madison 53715, USA.
Mundt
M P
MP
French
M T
MT
Manwell
L B
LB
Stauffacher
E A
EA
Barry
K L
KL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000517:prevention & control*; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics / Q000379:methods*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D015397:Program Evaluation; D016896:Treatment Outcome; D014922:Wisconsin