Emergency department based intervention with adolescent substance users: 10year economic and health outcomes.
Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents.



We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12-19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models.



Those who received the intervention had lower costs ($22 versus $227: z=3.16, p=0.002) and rates (0.03 versus 0.25: z=2.57, p=0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p=0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p=0.924), overall ED presentations ($4266 versus $4150, p=0.916), out-patient mental health services ($4494 versus $7717, p=0.282), or opiate pharmacotherapies ($1013 versus $2054, p=0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z=2.64, p=0.008).



An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.
National Drug Research Institute, Faculty Health Science, Curtin University, Australia. Electronic address: Robert.tait@curtin.edu.au.
Robert J
RJ
Tait
School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia; School of Population Health, the University of Western Australia, Australia.
Lucinda
L
Teoh
School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia.
Erin
E
Kelty
School of Population Health, the University of Western Australia, Australia.
Elizabeth
E
Geelhoed
School of Primary, Aboriginal & Rural Health Care, the University of Western Australia, Australia; Department of Emergency Medicine Sir Charles Gairdner Hospital, Perth, Australia.
David
D
Mountain
School of Psychiatry and Clinical Neurosciences, the University of Western Australia, Australia.
Gary K
GK
Hulse
D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends; D005102:Health Expenditures / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000191:economics / Q000639:trends; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Adolescent; Brief intervention; Costs; Emergency department; Services