Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings

BACKGROUND. Few studies have estimated the economic costs and benefits of b rief physician advice in managed care settings. OBJECTIVE. TO conduct a benefit-cost analysis of brief physician advice reg arding problem drinking. DESIGN. Patient and health care costs associated with brief advice were com pared with economic benefits associated with changes in health care utiliza tion, legal events, and motor vehicle accidents using 6- and 12-month follo w-up data from Project TrEAT (Trial for Early Alcohol Treatment), a randomi zed controlled clinical trial. SUBJECTS. 482 men and 292 women who reported drinking above a threshold lim it were randomized into control (n = 382) or intervention (n = 392) groups. MEASURES. Outcomes included alcohol use, emergency department visits, hospi tal days, legal events, and motor vehicle accidents. RESULTS. No significant differences between control and intervention subjec ts were present for baseline alcohol use, age, socioeconomic status, smokin g, depression or anxiety, conduct disorders, drug use, crimes, motor vehicl e accidents, or health care utilization. The total economic benefit of the brief intervention was $423,519 (95% CI: $35,947, $884,848), composed of $1 95,448 (95% CI: $36,734, $389,160) in savings in emergency department and h ospital use and $228,071 (95% CI: -$191,419, $757,303) in avoided costs of crime and motor vehicle accidents. The average (per subject) benefit was $1 ,151 (95% CI: $92, $2,257). The estimated total economic cost of the interv ention was $80,210, or $205 per subject. The benefit-cost ratio was 5.6:1 ( 95% CI: 0.4, 11.0), or $56,263 in total benefit for every $10,000 invested. CONCLUSIONS. These results offer the first quantitative evidence that imple mentation of a brief intervention for problem drinkers can generate positiv e net benefit for patients, the health care system and society.