Brief physician advice for problem drinking among older adults: an economic analysis of costs and benefits

Department of Family Medicine, University of Wisconsin, 777 South Mills Street, Madison, Wisconsin 53715, USA.
Journal of studies on alcohol 06/2005; 66(3):389-94. DOI: 10.15288/jsa.2005.66.389
Source: PubMed

ABSTRACT Problem alcohol use among elderly persons can have a variety of health-related consequences, complicating management of chronic illnesses and increasing health care utilization and costs. This study evaluates the economic cost and benefits of brief intervention for at-risk drinking older adults.
A controlled clinical trial with 24-month follow-up tested effectiveness of brief physician advice in reducing alcohol use, health care utilization and other consequences among older (age 65 or older) adult problem drinkers. Of 6,073 patients screened for problem drinking in 24 community-based primary care practices in Wisconsin, 158 patients met inclusion criteria and were randomized into control (n = 71) or intervention (n = 87) groups. Intervention group patients received two 10- to 15-minute physician-delivered counseling sessions including professional advice, education and contracting using scripted workbooks.
The intervention group demonstrated significant reductions in alcohol use (p = 0.001) and frequency of excessive drinking (p = 0.03) compared with the control group over 24 months, but no significant differences emerged in economic outcomes, including hospital days, emergency department visits, office visits, medications, lab and x-ray procedures, injuries, legal events or mortality.
Although the clinical benefits of brief alcohol interventions with older adults are clear, the economic results in this age group are less certain. Older adult problem drinkers may require more intensive and costly interventions to achieve economic benefits similar to those seen in younger adult problem drinkers. Methodological issues, such as statistical power, outcome measures, outlier cases and follow-up periods, are identified for future evaluations.

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Available from: Marlon P Mundt, Sep 29, 2015
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    • "With regards to the total duration of the intervention (i.e., the total contact time between patient and delivery staff, either face-to-face or over the telephone, aggregated over multiple contacts where appropriate), 12 studies evaluate interventions of 10 min or less (4, 13–15, 20, 23, 25, 28, 32, 33) and 11 consider interventions of over 10 min (with a maximum duration of 45 min) (4, 7, 13, 14, 16, 18, 21, 26, 28, 29). Again the heterogeneity of methods and outcomes makes direct comparison difficult, although there is no clear difference in terms of cost-effectiveness between shorter and longer interventions. "
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    ABSTRACT: Introduction: The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. Methods: Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. Results: The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. Conclusion: This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
    Frontiers in Psychiatry 09/2014; 5:114. DOI:10.3389/fpsyt.2014.00114
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    • "Mundt and colleagues [23] examined older adults (105 men and 53 women, aged 65 and older) who received a brief intervention by a physician through assessment, feedback, contracting and goal setting. Results indicated a 40% decrease in average weekly alcohol consumption compared to 6% in the control group in 3-month follow-up and maintained significantly lower levels of alcohol consumption and heavy episodic drinking throughout a 24-month observation period. "
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    ABSTRACT: The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and two pharmacotherapy studies from Europe. In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.
    International Journal of Environmental Research and Public Health 08/2011; 8(8):3351-64. DOI:10.3390/ijerph8083351 · 2.06 Impact Factor
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    • "(6) ) ( / ) ( r SOC q r FOC dq dr ∂ ∂ − = , 5 Mundt et al. (2005) "
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    ABSTRACT: Basic economic theory suggests that health insurance coverage may cause a reduction in prevention activities, but empirical studies have yet to provide much evidence to support this prediction. However, in other insurance contexts that involve adverse health events, evidence of ex ante moral hazard is more consistent. In this paper, we extend the analysis of the effect of health insurance on health behaviors by allowing for the possibility that health insurance has a direct (ex ante moral hazard) and indirect effect on health behaviors. The indirect effect works through changes in health promotion information and the probability of illness that may be a byproduct of insurance-induced greater contact with medical professionals. We identify these two effects and in doing so identify the pure ex ante moral hazard effect. This study exploits the plausibly exogenous variation in health insurance as a result of obtaining Medicare coverage at age 65. We find evidence that obtaining health insurance reduces prevention and increases unhealthy behaviors among elderly men. We also find evidence that physician counseling is successful in changing health behaviors.
    International Journal of Health Care Finance and Economics 04/2009; 9(4):367-90. DOI:10.1007/s10754-009-9056-4 · 0.49 Impact Factor
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