Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.
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.
Neighbors
Charles J
CJ
The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 19th Floor, New York, New York 10017, USA. cneighbors@casacolumbia.org
Barnett
Nancy P
NP
Rohsenow
Damaris J
DJ
Colby
Suzanne M
SM
Monti
Peter M
PM
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
J Consult Clin Psychol. 1999 Dec;67(6):989-94
10596521
Addiction. 2007 Aug;102(8):1234-43
17565560
J Stud Alcohol. 2000 May;61(3):387-95
10807209
Qual Life Res. 1998 Feb;7(2):101-14
9523491
Alcohol Clin Exp Res. 1994 Apr;18(2):261-4
8048724
Pharmacoeconomics. 1998 Oct;14(4):357-63
10344904
J Pediatr Psychol. 1997 Aug;22(4):513-31
9302849
Med Care. 2000 Jan;38(1):7-18
10630716
Pediatrics. 2000 Feb;105(2):E27
10654987
Drug Alcohol Depend. 1999 Jul 1;55(3):187-207
10428361
Accid Anal Prev. 1998 Mar;30(2):137-50
9450118
J Stud Alcohol. 2001 Nov;62(6):806-16
11838918
J Stud Alcohol. 1993 Sep;54(5):600-13
8412150
Med Decis Making. 1985 Summer;5(2):157-77
3831638
Arch Intern Med. 2004 Mar 8;164(5):531-7
15006830
N Engl J Med. 1996 Mar 7;334(10):642-6
8592529
J Am Coll Health. 2003 Jul-Aug;52(1):7-16
14717575
Acad Emerg Med. 2003 Jan;10(1):79-84
12511321
Ann Surg. 2005 Apr;241(4):541-50
15798453
Ann Surg. 1999 Oct;230(4):473-80; discussion 480-3
10522717
Arch Intern Med. 2003 Jul 28;163(14):1637-41
12885677
J Stud Alcohol. 2004 May;65(3):363-70
15222593
Risk Anal. 1995 Jun;15(3):369-90
7604170
J Safety Res. 2003 Jan;34(1):5-15
12535901
J Pediatr. 2004 Sep;145(3):396-402
15343198
Healthy People 2000 Stat Notes. 1995 Apr;(7):1-15
11762385
Drug Alcohol Depend. 2004 Jan 7;73(1):41-50
14687958
Pediatr Emerg Care. 2002 Oct;18(5):350-4
12395005
Health Econ. 2001 Dec;10(8):779-87
11747057
JAMA. 1997 Nov 5;278(17):1418-25
9356000
Natl Vital Stat Rep. 2002 Dec 19;51(3):1-38
12583542
Ann Emerg Med. 2005 Feb;45(2):118-27
15671966
J Stud Alcohol. 2002 Mar;63(2):136-44
12033690