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Purpose: Randomized controlled trials show that brief counseling can reduce hazardous alcohol use in primary care settings. However, the value and feasibility of screening all primary care patients for alcohol use and delivering these interventions have been questioned. The purpose of this study was to estimate the cost-effectiveness of alcohol screening and intervention in primary care.
Methods: We designed a Markov decision model to compare a strategy of alcohol screening and intervention to a strategy of no screening. The model tracked 6 alcohol-related health states (abstinence, safe drinking, at-risk drinking, alcohol abuse, alcohol dependence, and alcohol dependence in recovery). Model parameters were obtained from published values for: alcohol screening sensitivity/specificity, prevalence of alcohol problems in primary care, efficacy of brief intervention, transition between alcohol-related health states, mortality, costs for alcohol screening and intervention, and lifetime health care costs. Simplifying assumptions were made in cases where published data were not available. Standard gamble utility estimates for each alcohol-related health state were obtained from a clinic/community sample. We used separate models for men and women because transition probabilities between health states were substantially different by gender. We calculated the incremental cost-effectiveness ratio (cost per quality-adjusted life-year (QALY)) from the societal perspective and discounted costs and benefits at a rate of 3%.
Results: Under baseline conditions, the screening and intervention strategy dominated and was cost saving compared to the no screening strategy. In men, screening and intervention resulted in lifetime costs of $110,700 and 17.10 QALYs, and no screening resulted in costs of $111,000 and 17.05 QALYs. In women, screening and intervention resulted in lifetime costs of $110,200 and 17.15 QALYs, and no screening resulted in costs of $110,500 and 17.10 QALYs. Therefore, screening and intervention yielded a savings of $300 and a gain of 0.05 QALYs per man or woman screened. Results were robust to a range of alcohol use prevalence, intervention efficacy estimates, costs, utilities, and discount rates.
Conclusions: Screening and intervention for hazardous alcohol use in primary care extends quality-adjusted life and saves money. These results run counter to recent literature raising concerns about the value of alcohol screening and intervention in primary care and have the potential to inform clinical practice guidelines and policy decisions regarding the prevention of hazardous alcohol use.
See more of Oral Concurrent Session B - Clinical Effectiveness and Quality of Life
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)