Barbosa Carolina, Cowell Alexander, Bray Jeremy, Aldridge Arnie
RTI International, 230 West Monroe St., Suite 2100, Chicago, IL, USA 60606-4901.
RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709.
J Subst Abuse Treat. 2015 Jun;53:1-8. doi: 10.1016/j.jsat.2015.01.003. Epub 2015 Jan 15.
This 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.
A 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.
When 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% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained.
Alcohol 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.
本研究分析了与门诊医疗环境相比，在急诊科开展酒精筛查、简短干预及转介治疗（SBIRT）的成本效益。
采用概率决策分析树将患者分类为不同健康状态。为每个健康状态赋予效用权重和社会成本。健康结局指标包括随访时饮酒未超过阈值水平的患者比例、从基线时超过阈值水平转变为随访时戒酒或低于阈值水平的患者比例，以及获得的质量调整生命年（QALY）。从提供者角度来看，预期成本是SBIRT的边际成本，从社会角度来看，是每位患者的SBIRT成本与社会成本变化之和。计算增量成本效益比。
仅考虑提供者成本时，与门诊相比，急诊科的SBIRT每位患者成本少8.63美元，产生的QALY多0.005个，且饮酒低于阈值水平的患者多13.8%。在敏感性分析中，假设患者接受符合临床机构指南的固定疗程治疗，结果显示急诊科的SBIRT比门诊更昂贵；但急诊科仍然更有效。在该敏感性分析中，如果决策者愿意为每获得一个QALY支付超过1500美元，那么急诊科是最具成本效益的环境。
酒精SBIRT在急诊科和门诊环境中均能节省成本并改善健康状况。与门诊相比，急诊科以更低的成本和更大幅度的社会成本降低提供了更好的效果。
