Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers
Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers
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DOI：
10.1111/add.14668
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发表时间：
2019-09-01
期刊：
影响因子：
6
通讯作者：
Martino, Steve
中科院分区：
文献类型：
--
作者：
Olmstead, Todd A.;Yonkers, Kimberly A.;Martino, Steve
目的：确定电子和临床医生提供的SBIRT（筛查，短暂干预和转诊治疗）的成本效益，以减少在生殖健康中心治疗的妇女的主要物质使用。设计基于随机对照试验的成本-效果分析。关闭CT，USA研究对象：439名在生殖健康中心寻求常规护理的妇女，她们吸烟、饮酒、服用违禁药物或滥用处方药。参与者被随机分配到增强常规护理（EUC，n = 151），电子提供的SBIRT（e-SBIRT，n = 143）或临床医生提供的SBIRT（SBIRT，n = 145）。主要结果是在6个月的随访期间主要物质戒断的天数。为了解释患者在6个月随访期间可能用不同药物替代其主要药物的可能性，我们还考虑了戒断所有药物的天数。增量成本-效果比和成本-效果可接受性曲线从临床和患者的角度确定了这三种情况的相对成本-效果。结果从医疗保健提供者的角度来看，电子SBIRT是可能的（概率大于0. 5）是具有成本效益的任何愿意支付的价值为额外的一天的主要物质禁欲和额外的一天的所有物质禁欲。从病人的角度来看，EUC是最有可能是成本效益的干预时，愿意支付额外的一天的禁欲（包括主要物质和所有物质）是小于0.18美元和电子SBIRT是最有可能是成本效益的干预时，愿意支付额外的一天的禁欲（包括主要物质和所有物质）是大于0.18美元。结论e-SBIRT可能是一种具有成本效益的方法，从卫生保健提供者和患者的角度来看，用于生殖健康中心，以帮助妇女减少药物滥用。
Aims To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers. Design Cost-effectiveness analysis based on a randomized controlled trial. Setting New Haven, CT, USA. Participants A convenience sample of 439 women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication. Interventions Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145). Measurements The primary outcome was days of primary substance abstinence during the 6-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the 6-month follow-up period, we also considered the number of days of abstinence from all substances. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves determined the relative cost-effectiveness of the three conditions from both the clinic and patient perspectives. Findings From a health-care provider perspective, e-SBIRT is likely (with probability greater than 0.5) to be cost-effective for any willingness-to-pay value for an additional day of primary-substance abstinence and an additional day of all-substance abstinence. From a patient perspective, EUC is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is less than $0.18 and e-SBIRT is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18. Conclusions e-SBIRT could be a cost-effective approach, from both health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.