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Cost‐effectiveness of motivational intervention with significant others for patients with alcohol misuse
Author(s) -
Shepard Donald S.,
Lwin Aung K.,
Barnett Nancy P.,
Mastroleo Nadine,
Colby Suzanne M.,
Gwaltney Chad,
Monti Peter M.
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13233
Subject(s) - medicine , randomized controlled trial , confidence interval , cost effectiveness , intervention (counseling) , brief intervention , quality of life (healthcare) , physical therapy , emergency department , psychiatry , nursing , surgery , risk analysis (engineering)
Aims To estimate the incremental cost, cost‐effectiveness and benefit–cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. Design We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. Setting The underlying trial took place at a major urban hospital in the United States . Participants The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. Intervention 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. Measurements 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. Findings 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.