Brief Intervention Costs in Two Populations in the United States: College Students and US Air Force Personnel

1
Brief Intervention Costs in Two Populations in
the United States College Students and US Air
Force Personnel

• Presented by
• Alexander J. Cowell

Presented at INEBRIA, Gateshead, UK October 9,
2009
2
Acknowledgments

• PI for both is Dr. Janice Brown
• Air Force
• Many colleagues and collaborators at RTI and US
  Air Force
• Yuta Masuda and Brendan Wedehase
• Funding from Department of Defense
  W81XWH-04-1-0072
• College
• Yuta Masuda and Brendan Wedehase
• Many colleagues and collaborators at RTI and
  study site
• National Institute on Alcohol Abuse and
  Alcoholism of the National Institutes of Health
  R01 AA014374-02

3
Background

• Intervene with risky drinkers
• Both populations have problem drinkers
• Young adults aged 18 to 25 are the age group with
  the highest rates of heavy alcohol use
• Air Force population In 2005, 10.3 of Air Force
  personnel in the sample reported heavy drinking
  over the past 30 days (Bray and Hourani, 2007)
• College population In 2001, 44 of college
  students in the sample reported binge drinking
  (Wechsler et al., 2002)
• Little known about cost of MI for these groups

4
Methods Treatment Groups

• Air Force
• 4 bases
• 3 study arms
• Treatment as Usual (TAU)
• A full day of alcohol education and information
  sessions
• 6-10 hour session
• Group MI (GMI)
• MI in a group of 3 5
• 2-2.5 hour session
• Individual MI (IMI)
• Usual MI
• 0.5-1.5 hour session

• College
• 1 university campus
• 4 study arms
• Assessment Only
• No treatment
• Feedback
• Feedback report based on participant drinking
  habits
• MI Only
• MI with Feedback

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Methods Main Study

• Eligibility
• Preliminary screening
• Air Force referral
• College at recruitment
• AUDIT or other screening
• Exclude dependents
• Include risky drinkers
• Outcomes
• Survey
• Number of drinking days in past 30 days
• Number of heavy episodic drinking days in past 30
  days
• Average drinks per drinking day

6
Methods Economic Evaluation

• Cost Perspective
• Air Force and client
• College
• Cost P Q
• Price
• From various records
• Quantity
• Detailed records of activities
• Log kept by interventionists

7
RESULTS

• Air Force

8
Startup Costs (2009)
9
Time per Intervention (minutes)
10
Cost per Client of Providing the Intervention
(2009)
11
Cost per Client of Clients Time and Expenses
(2009)
12
Total Cost (2009)
13
RESULTS

• College

14
Trainee Time
15
Startup Costs (2009)
16
Time per Intervention (minutes)
17
Cost per Intervention (2009)
18
Cost per Intervention Sensitivity Analysis (2009)
19
Comparing the Two Studies

20
Comparison of Start-up Costs
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Comparison of MI Cost

• Average length of MI
• Air Force MI 80 minutes
• College MI 33 minutes

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Discussion and Conclusion

• Similar start-up costs
• Different implementation costs
• Next Step Cost-Effectiveness
• Evidence for both studies of improvement in
  outcome
• Air Force
• Outcome study has low n and high attrition
• If value of client time is included, TAU is not
  likely to be cost-effective
• College
• Outcome study has high n and low attrition
• Sensitivity of conclusions to assumptions made in
  feedback only arm may well affect
  cost-effectiveness conclusions