COST OF COMORBID ALCOHOL AND DRUG PROBLEMS

The authors measured the comorbid effect of alcohol and other drug (AO D) problems on medical surgical, and psychiatric inpatient charges and length of stay (LOS) in an urban hospital by use of retrospective stu dy of hospital clinical computer data comparing AOD-affected patients with non-AOD-affected patients in terms of cost, diagnostic, demograph ic, and utilization variables (N = 14,768). Patients were men and wome n with and without comorbid history of AOD problems, admitted for medi cal, surgical, and psychiatric reasons. For 10 of the 20 most frequent Diagnosis-Related Groups (DRGs), total hospital charges and LOS were significantly lower inpatients with comorbid AOD problems (P < 0.001). Overall, for the most frequent 20 DRGs, total charges and LOS remaine d significantly lower for the AOD group. Most physicians believed that AOD-affected patients were often less ill than non-AOD patients withi n the same DRG. Alcohol/drug-affected patients had robustly lower cost s and LOS. Fragmentation of psychosocial costs and addiction treatment from general health care and the fee-for-service DRG system appear to financially reward acute-care hospitals to repeatedly treat secondary AOD sequelae without Providing any apparent incentives for the treatm ent of the primary alcohol/drug condition itself.