Alcohol interventions for trauma patients treated in emergency departments and hospitals - A cost benefit analysis
Alcohol interventions for trauma patients treated in emergency departments and hospitals - A cost benefit analysis
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DOI：
10.1097/01.sla.0000157133.80396.1c
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发表时间：
2005-04-01
影响因子：
9
通讯作者：
Rivara, FP
中科院分区：
文献类型：
--
作者：
Gentilello, LM;Ebel, BE;Rivara, FP
目的：确定创伤中心短暂的酒精干预是否能降低医疗费用。背景资料：酒精使用障碍是造成伤害的主要原因。创伤患者的简短干预减少随后的酒精摄入和伤害累犯，但尚未广泛实施。方法：采用成本效益分析。研究人群包括在急诊科或医院接受治疗的受伤患者。该分析仅限于与伤害有关的直接医疗费用，以便对负责医疗保健费用的医院、保险公司和政府机构最有意义。用于得出未来效益的基本假设，包括成本、伤害率和干预效果，来自已公布的全国数据库、流行病学和临床试验数据。采用I-way敏感性分析对模型参数进行检验，并计算成本效益比。采用蒙特卡罗分析确定策略选择置信区间。结果：估计27%的受伤成年患者可以进行短暂的酒精干预。干预的净成本节省为每位接受筛查的患者89美元，或每位接受干预的患者330美元。减少保健支出带来的好处是，在筛查和干预方面每花费1美元，就节省3.81美元。这一发现对于接受干预的可能性、筛查和干预的成本以及伤害再犯的风险等各种假设都是强有力的。蒙特卡洛模拟发现，在91.5%的模拟跑步中，提供简短的干预可以节省医疗费用。如果在全国范围内定期向符合条件的成年受伤患者提供干预措施，每年可能节省18.2亿美元。结论：对创伤患者的酒精问题进行筛查和短暂干预具有成本效益，应常规实施。
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 I-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 per patient screened, or $330 for each patient offered an intervention. The benefit in reduced health expenditures resulted in savings of $3.81 for every $1.00 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 annually.Conclusions: Screening and brief intervention for alcohol problems in trauma patients is cost-effective and should be routinely implemented.