Transcript Document 7509182

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
www.rti.org
RTI International is a trade name of Research Triangle Institute
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
2
www.rti.org
5/24/2016
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
3
www.rti.org
5/24/2016
Methods: Treatment Groups
Air Force
College
• 4 bases
• 3 study arms
• 1 university campus
• 4 study arms
– Treatment as Usual (TAU)
• A full day of alcohol
education and information
sessions
• 6-10 hour session
– Assessment Only
• No treatment
– Feedback
• Feedback report based on
participant drinking habits
– Group MI (GMI)
– MI Only
• MI in a group of 3 – 5
• 2-2.5 hour session
– MI with Feedback
– Individual MI (IMI)
• Usual MI
• 0.5-1.5 hour session
4
www.rti.org
5/24/2016
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
5
www.rti.org
5/24/2016
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
6
www.rti.org
5/24/2016
RESULTS
Air Force
7
www.rti.org
5/24/2016
Startup Costs (€2009)
Staff
Cost per Trainee Number Trained Total Cost
€ 1,135
29
€ 32,903
8
www.rti.org
5/24/2016
Time per Intervention (minutes)
n
Time Delivering Session
Time Supporting Session
Total
115
80
31
112
143
119
53
173
844
451
102
553
9
www.rti.org
5/24/2016
Cost per Client of Providing the Intervention
(€2009)
IMI
n
115
Total Cost € 35.80
GMI
143
€ 16.12
TAU
844
€ 15.11
10
www.rti.org
5/24/2016
Cost per Client of Client’s Time and
Expenses (€2009)
Cost Categories
Client travel time cost
Transportation cost
Client session time cost
Total Cost
€
€
€
€
IMI
3.17
3.40
15.07
21.64
€
€
€
€
GMI
3.91
3.69
23.91
31.51
€
€
€
€
TAU
3.17
3.47
79.30
85.94
11
www.rti.org
5/24/2016
Total Cost (€2009)
n
Total Cost
IMI
115
€ 57.45
GMI
143
€ 47.62
TAU
844
€ 101.05
12
www.rti.org
5/24/2016
RESULTS
College
13
www.rti.org
5/24/2016
Trainee Time
70
60
Hours
50
40
Original Staff
Replacement Staff
30
20
10
0
Formal
Training
On-the-job Homework
Training
Total
14
www.rti.org
5/24/2016
Startup Costs (€2009)
Cost Category
Cost per Trainee Number Trained Total Cost
Original Staff
€ 1,591
4
€ 6,364
Replacement Staff
€ 1,171
13
€ 15,219
Equipment Cost
€ 3,397
15
www.rti.org
5/24/2016
Time per Intervention (minutes)
Activity
n
Answering Feedback Questions
Preparing Feedback Report
Conducting MI
Total Time
Feedback MI Only MI with Feedback
190
183
164
21
21
19
19
33
38
39
33
77
16
www.rti.org
5/24/2016
Cost per Intervention (€2009)
Cost Category
Feedback MI Only MI with Feedback
n
190
183
164
Feedback Questions
€ 4.89
€ 4.68
Preparing Feedback Report
€ 6.27
€ 6.30
MI
€ 11.28
€ 12.79
€11.15‡
€11.28‡
€23.76*†
Total Cost
*p<.01 versus Feedback
†
p<.01 versus MI Only
‡
p<.01 versus MI with Feedback
17
www.rti.org
5/24/2016
Cost per Intervention Sensitivity Analysis
(€2009)
Cost Category
n
Total Cost with Assessment Oversight
Total Cost without Assessment Oversight
*p<.01 versus Feedback
†
p<.01 versus MI Only
‡
p<.01 versus MI with Feedback
Feedback MI Only MI with Feedback
190
183
164
€11.15‡ €11.28‡
€23.76*†
€6.26†‡ €11.28*‡
€19.08*†
18
www.rti.org
5/24/2016
Comparing the Two Studies
19
www.rti.org
5/24/2016
Comparison of Start-up Costs
Study
Cost per Trainee Number Trained Total Cost
Air Force MI
€ 1,135
29
€ 32,903
College MI
€ 1,270
17
€ 21,583
20
www.rti.org
5/24/2016
Comparison of MI Cost
Study
Air Force with both session
and administrative time
Air Force with session time
College with session time
Cost of MI
€ 35.80
€ 25.79
€ 11.28
•Average length of MI
•Air Force MI: 80 minutes
•College MI: 33 minutes
21
www.rti.org
5/24/2016
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 costeffective
• 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
22
www.rti.org
5/24/2016