Program-and service-level costs of seven screening, brief intervention, and referral to treatment programs

This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models

The Cost-Effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings

ObjectiveThis 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.MethodsA 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.ResultsWhen 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$1500 per QALY gained.ConclusionsAlcohol 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

Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice

Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients who received MTM without use of the TA scale (MTM only). Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics. Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting. Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2. Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome Measures Proportion of Days Covered (PDC) and PDC80. Results: Using the therapeutic alliance scales in the context of community pharmacist-provided MTM was associated with a 3.1 percentage point increase in patients' overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales. Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice. Type: Original Researc

Estimation of Breast Cancer Incident Cases and Medical Care Costs Attributable to Alcohol Consumption Among Insured Women Aged <45 Years in the U.S.

This study estimated the percentage of breast cancer cases, total number of incident cases, and total annual medical care costs attributable to alcohol consumption among insured younger women (aged 18–44 years) by type of insurance and stage at diagnosis

Screening, Brief Intervention, and Referral to Treatment in the Emergency Department:An Examination of Health Care Utilization and Costs

BACKGROUND:There is increasing interest in deploying screening, brief intervention, and referral to treatment (SBIRT) practices in emergency departments (ED) to intervene with patients at risk for substance use disorders. However, the current literature is inconclusive on whether SBIRT practices are effective in reducing costs and utilization. OBJECTIVE:This study sought to evaluate the health care costs and health care utilization associated with SBIRT services in the ED. RESEARCH DESIGN:This study analyzed downstream health care utilization and costs for patients who were exposed to SBIRT services within an Allegheny County, Pennsylvania, ED through a program titled Safe Landing compared with 3 control groups of ED patients (intervention hospital preintervention, and preintervention and postintervention time period at a comparable, nonintervention hospital). SUBJECTS:The subjects were patients who received ED SBIRT services from January 1 to December 31 in 2012 as part of the Safe Landing program. One control group received ED services at the same hospital during a previous year. Two other control groups were patients who received ED services at another comparable hospital. MEASURES:Measures include total health care costs, 30-day ED visits, 1-year ED visits, inpatient claims, and behavioral health claims. RESULTS:Results found that patients who received SBIRT services experienced a 21% reduction in health care costs and a significant reduction in 1-year ED visits (decrease of 3.3 percentage points). CONCLUSIONS:This study provides further support that SBIRT programs are cost-effective and cost-beneficial approaches to substance use disorders management, important factors as policy advocates continue to disseminate SBIRT practices throughout the health care system

The relative impact of brief treatment versus brief intervention in primary health-care screening programs for substance use disorders

AIMS:To assess the relative impact of brief treatment (BT) compared with brief intervention (BI) on changes in substance use behavior in primary care screening programs for substance use disorders, overall and by patient severity. DESIGN AND PARTICIPANTS:A total of 9029 patients with both baseline and follow-up interviews were identified in the US Government Performance and Results Act (GPRA) data from October 2004 and February 2008. Using a propensity score framework, multiple generalized linear mixed models and a local linear matching method with a difference in difference estimator, patients from the BI group that resemble BT patients were used to determine the relative treatment effect of BT. A total of 3218 of these US patients with baseline and follow-up interviews were used in the final analysis sample after the propensity score-matching procedure (1448 patients assigned to a BI service category and 1770 assigned to a BT service category). SETTING:United States. MEASUREMENTS:Dependent variables were the number of days of use in the past 30 days of any alcohol, alcohol to intoxication, illicit drugs and marijuana. FINDINGS:The relative impact of BT was not significant for alcohol (0.269; P > 0.1) or alcohol to intoxication (0.462; P > 0.1). BT was found to reduce the frequency of use of illicit drugs at follow-up by 0.634 days more than BI (P  0.1). Higher severity patients assigned to BT had a decrease in days of illicit drug use of 1.765 (