scholarly journals Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: pilot study

2009 ◽  
Vol 195 (5) ◽  
pp. 448-456 ◽  
Author(s):  
Colin Drummond ◽  
Simon Coulton ◽  
Darren James ◽  
Christine Godfrey ◽  
Steve Parrott ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Alcohol Use ◽  
Practice Nurse ◽  
Alcohol Use Disorders ◽  
Cost Savings ◽  
Stepped Care ◽  
Minimal Intervention ◽  
Care Intervention ◽  
Wide Range

BackgroundScreening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial.AimsTo evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care.MethodA total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency.ResultsBoth groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention.ConclusionsStepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.

scholarly journals Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

2017 ◽  
Vol 177 (10) ◽  
pp. 1480 ◽  
Author(s):  
Katherine E. Watkins ◽  
Allison J. Ober ◽  
Karen Lamp ◽  
Mimi Lind ◽  
Claude Setodji ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Collaborative Care ◽  
Alcohol Use Disorders

scholarly journals Opportunistic screening for alcohol use disorders in primary care: comparative study

BMJ ◽  
2006 ◽  
Vol 332 (7540) ◽  
pp. 511-517 ◽  
Author(s):  
Simon Coulton ◽  
Colin Drummond ◽  
Darren James ◽  
Christine Godfrey ◽  
J Martin Bland ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Comparative Study ◽  
Alcohol Use Disorders ◽  
Opportunistic Screening

Incremental cost-effectiveness of a collaborative care intervention for panic disorder

2006 ◽  
Vol 36 (3) ◽  
pp. 353-363 ◽  
Author(s):  
WAYNE KATON ◽  
JOAN RUSSO ◽  
CATHY SHERBOURNE ◽  
MURRAY B. STEIN ◽  
MICHELLE CRASKE ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Panic Disorder ◽  
Incremental Cost ◽  
Usual Care ◽  
Moderate Increase ◽  
Patient Costs ◽  
Care Intervention ◽  
Life Years ◽  
Primary Care Patients

Background. Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment.Method. This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs).Results. Relative to usual care, intervention patients experienced 60·4 [95% confidence interval (CI) 42·9–77·9] more AFDs over a 12-month period. Total incremental out-patient costs were $492 higher (95% CI $236–747) in intervention versus usual care patients with a cost per additional AFD of $8.40 (95% CI $2.80–14.0) and a cost per QALY ranging from $14158 (95% CI $6791–21496) to $24776 (95% CI $11885–37618). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension.Conclusions. The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

Medications for Alcohol Use Disorders in a Primary Care Practice-Based Research Network Implementation Study

2014 ◽  
Vol 32 (1) ◽  
pp. 58-66
Author(s):  
Andrea M. Wessell ◽  
Lynne S. Nemeth ◽  
Ruth G. Jenkins ◽  
Steven M. Ornstein ◽  
Peter M. Miller
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Practice ◽  
Alcohol Use Disorders ◽  
Research Network ◽  
Care Practice ◽  
Implementation Study ◽  
Practice Based Research

scholarly journals COST-EFFECTIVENESS ANALYSIS OF THE COLLABORATIVE STEPPED CARE INTERVENTION FOR LATE-LIFE DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S876-S877
Author(s):  
Shiyu Lu ◽  
Gloria H Y Wong ◽  
Terry Lum ◽  
Tianyin Liu
Keyword(s):  
Cost Effectiveness ◽  
Intervention Group ◽  
Late Life ◽  
Community Dwelling ◽  
Stepped Care ◽  
Care Group ◽  
Care Utilization ◽  
Late Life Depression ◽  
Care Intervention ◽  
The Cost

Abstract Late-life depression is a burden on society because it is costly and have a significant adverse effect on the quality of life. The aim of this study is to evaluate the cost-effectiveness of the collaborative stepped care intervention for depression among community-dwelling older adults compared to care as usual from a societal perspective. The intervention was piloted from 2016-2019 in Hong Kong. The study used a two-armed quasi-experimental design. Eventually, 412 older people were included (314 collaborative stepped care, 98 care as usual). Baseline measures and 12-month follow-up measures were assessed using questionnaires. We applied the 5-level EQ-5D version (EQ-5D-5L) and the Client Service Receipt Inventory (CSRI) respectively measuring quality-adjusted life-year (QALY) and health care utilization. The average annual direct medical cost in the intervention group was USD 6,589 (95% C.I., 4,979 to 8,199) compared to US$ 6,167 (95% C.I., 3,702 to 8,631) in the care as usual group. The average QALYs gained was 0.036 higher in the collaborative stepped care group, leading to an incremental cost-effectiveness ratio (ICER) of US$ 11,722 per QALY, lower than the cost-effectiveness threshold suggested by The National Institute for Health and Clinical Excellence. The study showed that collaborative stepped care was a cost-effective intervention for late-life depression over service as usual.

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