医院急诊室中针对酒精相关青少年的动机干预的成本效益。
Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department.
机构信息
The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 19th Floor, New York, New York 10017, USA.
出版信息
J Stud Alcohol Drugs. 2010 May;71(3):384-94. doi: 10.15288/jsad.2010.71.384.
OBJECTIVE
Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained.
METHOD
Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases.
RESULTS
Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates.
CONCLUSIONS
This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.
目的
针对冒险青年的急诊简短干预措施显示出减少与酒精相关伤害的潜力。本研究模拟了基于动机访谈的干预措施相对于停止与酒精相关的风险行为的简短建议（标准护理）的成本效益。在条件之间比较了平均成本效益比。此外，成本效益分析检查了每获得一个质量调整生命年的动机访谈的增量成本。
方法
使用微观成本法来估计动机访谈和标准护理的边际成本，以及两种患者筛选方法：标准急诊部工作人员提问和咨询人员主动外展。计算了饮酒和驾驶、伤害、车辆传票和负面社会后果的平均成本效益比。使用动机访谈减少饮酒和驾驶的边际效应的估计值、饮酒和驾驶青年的交通死亡风险的估计值以及国家生命表，还估计了与标准护理相比，动机访谈每节省一个质量调整生命年的社会成本。使用国家数据库估计了与酒精相关的交通死亡风险。
结果
每位参与者的干预成本分别为标准护理 81 美元、标准筛查的动机访谈 170 美元和主动筛查的动机访谈 173 美元。动机访谈的成本效益比在所有研究结果中均优于标准护理，对男性的效果优于女性。动机访谈的每质量调整生命年的社会成本为 8795 美元。敏感性分析表明，结果在参数估计的可变性方面具有稳健性。
结论
与其他常见的医疗干预措施相比，这种简短的干预措施是对社会的良好投资。
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