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. 2024 Dec 3:12:1322327.
doi: 10.3389/fpubh.2024.1322327. eCollection 2024.

Effects of alcohol-related problems on the costs of frequent emergency department use: an economic analysis of a case-control study in Spain

Clara Oliveras  1   2   3   4 , Pol Bruguera  1   2   3   4 , Imanol Cordero-Torres  5 , Andrea Millán-Hernández  3 , Maria Teresa Pons-Cabrera  1   2   3 , Pablo Rodrigo Guzmán Cortez  1   2   3 , Marta Gómez-Ramiro  2   5   6   7   8 , Mireia Vázquez  2   5 , Roger Borràs  9 , Maria Asenjo-Romero  5 , Eduard Vieta  2   6   10 , Antoni Gual  1   2   3   4 , Hugo López-Pelayo  1   2   3   4 , Mercè Balcells-Oliveró  1   2   3   4
Affiliations

Effects of alcohol-related problems on the costs of frequent emergency department use: an economic analysis of a case-control study in Spain

Clara Oliveras et al. Front Public Health. .

Abstract

Introduction: Alcohol-related problems increase the probability of frequent emergency department (ED) use. In this study, we compared the direct healthcare expenses incurred during a single visit among frequent and non-frequent ED users and analyzed the impact of alcohol-related issues in healthcare costs arising from ED usage.

Methods: The study relied on secondary analyses of economic data from a 1:1 matched case-control study with the primary aim of identifying the clinical characteristics of hospital ED frequent users in a Mediterranean European environment with a public, universal, and tax-funded health system. The participants ranged in age from 18 to 65 years and underwent ED visits at a high-complexity Spanish hospital (cases ≥5 times, controls <5) from December 2018 to November 2019. Each case was matched to a control with the same age, gender, and date of attendance at the ED. Clinical data and direct healthcare costs for a single ED visit were obtained by a retrospective review of the first electronic medical register. Costs and duration of stay were compared between cases and controls using paired-samples t-tests, and ED users with and without alcohol-related problems were compared using bivariate (independent-samples t-tests, one-way analysis of variance, Chi square tests, and multiple linear regression) and multivariate analyses (multiple linear regression models with backward stepwise selection algorithm, and dependent variable: total mean direct costs).

Results: Among 609 case-control pairs (total n = 1218), mean total healthcare direct costs per ED visit were 22.2% higher among frequent compared with non-frequent users [mean difference 44.44 euros; 95% confidence interval (CI) 13.4-75.5; t(608) = 2.811; p = 0.005]. Multiple linear regression identified length of stay, triage level, ambulance arrival, and the specialty discharging the patient as associated with total healthcare costs for frequent users. In bivariate analyses, a history of alcohol-related problems was associated with a 32.5% higher mean total healthcare costs among frequent users [mean difference 72.61 euros; 95% confidence interval 25.24-119.97; t(320.016) = 3.015; p = 0.003].

Conclusion: The findings confirm the high cost of frequent ED use among people with alcohol-related problems, suggesting that costs could be reduced through implementation of intervention protocols.

Keywords: alcohol; emergency department; frequent users; healthcare costs; psychiatry.

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Conflict of interest statement

CO has received travel grants from Lundbeck, which had no bearing on the research of this study. PB has received honoraria from Lundbeck and travel grants from Pfizer, Lundbeck and Camurus, all outside the work of this manuscript. MTPC has received financial support for CME activities and travel funds from Lundbeck, Pfizer, and Esteve, outside the submitted work. MG-R has received funding unrelated to the present work for research projects and/or honoraria as a consultant or speaker from the following entities: Angelini, Janssen, Lundbeck, Otsuka, Sanofi-Aventis and Spanish Ministry of Science and Innovation- Instituto de Salud Carlos III. EV has received grants and served as consultant, advisor or CME speaker for the following entities: ABBiotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Novartis, Orion Corporation, Organon, Otsuka, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, outside the submitted work. AG has received honoraria, research grants and travel grants from Lundbeck and D&A Pharma, which had no bearing on the research of this study. HL-P has received honoraria and travel grants from Lundbeck, which had no bearing on the research of this study. MB-O has received travel grants from Lundbeck and Camurus and CME-related honoraria from Novo Nordisk, all outside the subject of this article. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Flowchart of participant selection.
See this image and copyright information in PMC

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