Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis

Abstract

Objective: To determine if brief alcohol interventions in trauma centers reduce health care costs.

Summary background data: Alcohol-use disorders are the leading cause of injury. Brief interventions in trauma patients reduce subsequent alcohol intake and injury recidivism but have not yet been widely implemented.

Methods: This was a cost-benefit analysis. The study population consisted of injured patients treated in an emergency department or admitted to a hospital. The analysis was restricted to direct injury-related medical costs only so that it would be most meaningful to hospitals, insurers, and government agencies responsible for health care costs. Underlying assumptions used to arrive at future benefits, including costs, injury rates, and intervention effectiveness, were derived from published nationwide databases, epidemiologic, and clinical trial data. Model parameters were examined with 1-way sensitivity analyses, and the cost-benefit ratio was calculated. Monte Carlo analysis was used to determine the strategy-selection confidence intervals.

Results: An estimated 27% of all injured adult patients are candidates for a brief alcohol intervention. The net cost savings of the intervention was 89 US dollars per patient screened, or 330 US dollars for each patient offered an intervention. The benefit in reduced health expenditures resulted in savings of 3.81 US dollars for every 1.00 US dollar spent on screening and intervention. This finding was robust to various assumptions regarding probability of accepting an intervention, cost of screening and intervention, and risk of injury recidivism. Monte Carlo simulations found that offering a brief intervention would save health care costs in 91.5% of simulated runs. If interventions were routinely offered to eligible injured adult patients nationwide, the potential net savings could approach 1.82 billion US dollars annually.

Conclusions: Screening and brief intervention for alcohol problems in trauma patients is cost-effective and should be routinely implemented.

FIGURE 1. Flow diagram illustrating potential outcomes related to screening and intervention strategies.

FIGURE 2. Sensitivity analysis demonstrating potential cost savings associated with variations in a number of primary variables. Screening and brief intervention is associated with cost savings when the bar is above zero. The estimated mean cost savings is $89 in US dollars (year 2000). BAI, brief alcohol intervention; ED, emergency department; RR, relative risk.

FIGURE 3. Histogram demonstrating likelihood of cost savings where variables are allowed to range simultaneously. In 91.5% of simulations, screening and intervention were associated with cost savings.