title: Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.
abstract: OBJECTIVE
  To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse.
  
  
  METHODS
  We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial.
  
  
  METHODS
  The underlying trial took place at a major urban hospital in the United States.
  
  
  METHODS
  The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit.
  
  
  METHODS
  The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited.
  
  
  METHODS
  We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained.
  
  
  RESULTS
  From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial.
  
  
  CONCLUSIONS
  Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective.
authors.affiliation: Schneider Institutes for Health Policy, The Heller School, Brandeis University, Waltham, MA, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, The Heller School, Brandeis University, Waltham, MA, USA.
authors.forename: Aung K
authors.initials: AK
authors.lastname: Lwin
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Barnett
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Mastroleo
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Colby
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Gwaltney
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Monti
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000191:economics / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D004638:Emergency Treatment; D005260:Female; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000191:economics / Q000379:methods*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: Benefit-cost analysis; cost-effectiveness analysis; economic evaluation; motivational intervention, alcohol treatment; significant other