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The Relationship Between End‐of‐Treatment Alcohol Use and Subsequent Healthcare Costs: Do Heavy Drinking Days Predict Higher Healthcare Costs?
Author(s) -
Aldridge Arnie P.,
Zarkin Gary A.,
Dowd William N.,
Bray Jeremy W.
Publication year - 2016
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.13054
Subject(s) - abstinence , heavy drinking , medicine , health care , environmental health , emergency medicine , demography , injury prevention , poison control , psychiatry , sociology , economics , economic growth
Background A challenge for evaluating alcohol treatment efficacy is determining what constitutes a “good” outcome or meaningful improvement. Abstinence at the end of treatment is an unambiguously good outcome; however, a focus on abstinence ignores the potential benefits of patients reducing their drinking to less problematic levels. Patients may be drinking at low‐risk levels at the end of treatment but may be high‐functioning and impose few social costs. In this study, we estimate the relationship between drinking at the end of COMBINE treatment and subsequent healthcare costs with an emphasis on heavy and nonheavy drinking levels. Methods Indicators of heavy drinking days ( HDD s ; 5+ drinks for men, 4+ for women) and nonheavy drinking days ( non‐ HDD s ) during the last 30 days of COMBINE treatment were constructed for 748 patients enrolled in the COMBINE Economic Study. Generalized linear models were used to model total costs following COMBINE treatment as a function of drinking indicators. Different model specifications analyzed alternative counts of HDD s (e.g., 1 HDD and 2 to 30 HDD s ), and groups having Both non‐ HDD s and HDD s . Results Patients with HDD s had 66.4% ( p < 0.01) higher healthcare costs than those who were abstinent. Having more than 2 HDD s was associated with the highest costs (75.9%, p < 0.01). Patients with non‐HDDs had costs that were not significantly different than abstainers, even if they also had HDDs. However, those with HDDs only had costs 91.7% higher than abstainers ( p < 0.01). Conclusions Having HDD s at the end of treatment is associated with higher costs. Patients who had Only HDD s at the end of treatment had worse subsequent outcomes than those who had Both non‐ HDD s and HDD s . These findings offer new context for evaluating treatment outcomes and provide new information on the association of drinking with consequences.