title: Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.
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.
  
  
  METHODS
  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.
authors.affiliation: The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 19th Floor, New York, New York 10017, USA. cneighbors@casacolumbia.org
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Neighbors
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Barnett
authors.forename: Damaris J
authors.initials: DJ
authors.lastname: Rohsenow
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Colby
authors.forename: Peter M
authors.initials: PM
authors.lastname: Monti
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence; D000293:Adolescent; D000428:Alcohol Drinking / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology; D019973:Alcohol-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D018803:Models, Economic; D009042:Motivation; D011614:Psychotherapy, Brief / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012309:Risk-Taking; D055815:Young Adult
references.citation: J Consult Clin Psychol. 1999 Dec;67(6):989-94
references.pmid: 10596521
references.citation: Addiction. 2007 Aug;102(8):1234-43
references.pmid: 17565560
references.citation: J Stud Alcohol. 2000 May;61(3):387-95
references.pmid: 10807209
references.citation: Qual Life Res. 1998 Feb;7(2):101-14
references.pmid: 9523491
references.citation: Alcohol Clin Exp Res. 1994 Apr;18(2):261-4
references.pmid: 8048724
references.citation: Pharmacoeconomics. 1998 Oct;14(4):357-63
references.pmid: 10344904
references.citation: J Pediatr Psychol. 1997 Aug;22(4):513-31
references.pmid: 9302849
references.citation: Med Care. 2000 Jan;38(1):7-18
references.pmid: 10630716
references.citation: Pediatrics. 2000 Feb;105(2):E27
references.pmid: 10654987
references.citation: Drug Alcohol Depend. 1999 Jul 1;55(3):187-207
references.pmid: 10428361
references.citation: Accid Anal Prev. 1998 Mar;30(2):137-50
references.pmid: 9450118
references.citation: J Stud Alcohol. 2001 Nov;62(6):806-16
references.pmid: 11838918
references.citation: J Stud Alcohol. 1993 Sep;54(5):600-13
references.pmid: 8412150
references.citation: Med Decis Making. 1985 Summer;5(2):157-77
references.pmid: 3831638
references.citation: Arch Intern Med. 2004 Mar 8;164(5):531-7
references.pmid: 15006830
references.citation: N Engl J Med. 1996 Mar 7;334(10):642-6
references.pmid: 8592529
references.citation: J Am Coll Health. 2003 Jul-Aug;52(1):7-16
references.pmid: 14717575
references.citation: Acad Emerg Med. 2003 Jan;10(1):79-84
references.pmid: 12511321
references.citation: Ann Surg. 2005 Apr;241(4):541-50
references.pmid: 15798453
references.citation: Ann Surg. 1999 Oct;230(4):473-80; discussion 480-3
references.pmid: 10522717
references.citation: Arch Intern Med. 2003 Jul 28;163(14):1637-41
references.pmid: 12885677
references.citation: J Stud Alcohol. 2004 May;65(3):363-70
references.pmid: 15222593
references.citation: Risk Anal. 1995 Jun;15(3):369-90
references.pmid: 7604170
references.citation: J Safety Res. 2003 Jan;34(1):5-15
references.pmid: 12535901
references.citation: J Pediatr. 2004 Sep;145(3):396-402
references.pmid: 15343198
references.citation: Healthy People 2000 Stat Notes. 1995 Apr;(7):1-15
references.pmid: 11762385
references.citation: Drug Alcohol Depend. 2004 Jan 7;73(1):41-50
references.pmid: 14687958
references.citation: Pediatr Emerg Care. 2002 Oct;18(5):350-4
references.pmid: 12395005
references.citation: Health Econ. 2001 Dec;10(8):779-87
references.pmid: 11747057
references.citation: JAMA. 1997 Nov 5;278(17):1418-25
references.pmid: 9356000
references.citation: Natl Vital Stat Rep. 2002 Dec 19;51(3):1-38
references.pmid: 12583542
references.citation: Ann Emerg Med. 2005 Feb;45(2):118-27
references.pmid: 15671966
references.citation: J Stud Alcohol. 2002 Mar;63(2):136-44
references.pmid: 12033690