title: The Cost-effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings.
abstract: OBJECTIVE
  This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings.
  
  
  METHODS
  A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed.
  
  
  RESULTS
  When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained.
  
  
  CONCLUSIONS
  Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient.
authors: RTI International, 230 West Monroe St., Suite 2100, Chicago, IL, USA 60606-4901. Electronic address: cbarbosa@rti.org.
authors: Carolina
authors: C
authors: Barbosa
authors: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709.
authors: Alexander
authors: A
authors: Cowell
authors: Bryan School of Business and Economics, 462 Bryan Building, P.O. Box 26170, UNC Greensboro, Greensboro, NC 27402-6170.
authors: Jeremy
authors: J
authors: Bray
authors: RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709.
authors: Arnie
authors: A
authors: Aldridge
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000191:economics / Q000628:therapy*; D000554:Ambulatory Care Facilities / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation
keywords: Alcohol; Cost-effectiveness; Emergency department; Outpatient; QALYs; SBI