PMID- 29946229
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 1478-7547 (Print)
IS  - 1478-7547 (Electronic)
IS  - 1478-7547 (Linking)
VI  - 16
DP  - 2018
TI  - Brief interventions to address substance use among patients presenting to 
      emergency departments in resource poor settings: a cost-effectiveness analysis.
PG  - 24
LID - 10.1186/s12962-018-0109-8 [doi]
LID - 24
AB  - BACKGROUND: There are limited data describing the cost-effectiveness of brief 
      interventions for substance use in resource-poor settings. Using a patient and 
      provider perspective, this study investigates the cost-effectiveness of a brief 
      motivational interviewing (MI) intervention versus a combined intervention of MI 
      and problem solving therapy (MI-PST) for reducing substance use among patients 
      presenting to emergency departments, in comparison to a control group. METHODS: 
      Effectiveness data were extracted from Project STRIVE (Substance use and Trauma 
      InterVention) conducted in South Africa. Patients were randomised to either 
      receive 1 session of MI (n = 113) or MI in addition to four sessions of PST 
      (n = 109) or no intervention [control (n = 110)]. Costs included the direct 
      health care costs associated with the interventions. Patient costs included out 
      of pocket payments incurred accessing the MI-PST intervention. Outcome measures 
      were patients' scores on the Alcohol, Smoking and Substance Use Involvement 
      Screening Test (ASSIST) and the Centre for Epidemiological Studies Depression 
      Scale (CES-D). RESULTS: Cost per patient was low in all three groups; US$16, 
      US$33 and US$11, and for MI, MI-PST and control respectively. Outcomes were 0.92 
      (MI), 1.06 (MI-PST) and 0.88 (control) for ASSIST scores; and 0.74 (MI), 1.27 
      (MI-PST) and 0.53 (control) for CES-D scores. In comparison to the control group, 
      the MI intervention costs an additional US$119 per unit reduction in ASSIST 
      score, (US$20 for CES-D); MI-PST in comparison to MI costs US$131 or US$33 per 
      unit reduction in ASSIST or CES-D scores respectively. The sensitivity analyses 
      showed that increasing the number of patients who screened positive and thus 
      received the intervention could improve the effectiveness and cost-effectiveness 
      of the interventions. CONCLUSION: MI or MI-PST interventions delivered by lay 
      counsellors have the potential to be cost-effective strategies for the reduction 
      of substance use disorder and depressive symptoms among patients presenting at 
      emergency departments in resource poor settings. Given the high economic, social 
      and health care cost of substance use disorders in South Africa, these results 
      suggest that these interventions should be carefully considered for future 
      implementation.Trial registration This study is part of a trial registered with 
      the Pan African Clinical Trial Registry (PACTR201308000591418).
FAU - Dwommoh, Rebecca
AU  - Dwommoh R
AUID- ORCID: 0000-0002-2261-0905
AD  - 1Health Economics Unit, School of Public Health and Family Medicine, Faculty of 
      Health Sciences, University of Cape Town, Observatory, Cape Town, 7925 South 
      Africa. ISNI: 0000 0004 1937 1151. GRID: grid.7836.a
AD  - 2Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana. ISNI: 0000 0004 
      0546 2044. GRID: grid.415375.1
FAU - Sorsdahl, Katherine
AU  - Sorsdahl K
AD  - 3Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & 
      Mental Health, University of Cape Town, Cape Town, 7925 South Africa. ISNI: 0000 
      0004 1937 1151. GRID: grid.7836.a
FAU - Myers, Bronwyn
AU  - Myers B
AD  - 4Department of Psychiatry & Mental Health, Groote Schuur Hospital, University of 
      Cape Town, Cape Town, 7925 South Africa. ISNI: 0000 0004 1937 1151. GRID: 
      grid.7836.a
AD  - 5Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research 
      Council, Tygerberg, 7505 South Africa. ISNI: 0000 0000 9155 0024. GRID: 
      grid.415021.3
FAU - Asante, Kwaku Poku
AU  - Asante KP
AD  - 2Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana. ISNI: 0000 0004 
      0546 2044. GRID: grid.415375.1
FAU - Naledi, Tracey
AU  - Naledi T
AD  - 6Western Cape Department of Health, 8 Riebeeck Street, Cape Town, 8001 South 
      Africa. ISNI: 0000 0004 0635 5945. GRID: grid.467135.2
FAU - Stein, Dan J
AU  - Stein DJ
AD  - 4Department of Psychiatry & Mental Health, Groote Schuur Hospital, University of 
      Cape Town, Cape Town, 7925 South Africa. ISNI: 0000 0004 1937 1151. GRID: 
      grid.7836.a
AD  - 7South African MRC Unit on Risk & Resilience in Mental Disorders, Department of 
      Psychiatry and Mental Health, University of Cape Town, Cape Town, 7925 South 
      Africa. ISNI: 0000 0004 1937 1151. GRID: grid.7836.a
FAU - Cleary, Susan
AU  - Cleary S
AD  - 1Health Economics Unit, School of Public Health and Family Medicine, Faculty of 
      Health Sciences, University of Cape Town, Observatory, Cape Town, 7925 South 
      Africa. ISNI: 0000 0004 1937 1151. GRID: grid.7836.a
LA  - eng
PT  - Journal Article
DEP - 20180618
PL  - England
TA  - Cost Eff Resour Alloc
JT  - Cost effectiveness and resource allocation : C/E
JID - 101170476
PMC - PMC6006568
OTO - NOTNLM
OT  - Brief interventions
OT  - Cost-effectiveness analysis
OT  - Emergency departments
OT  - Problem solving therapy
OT  - Substance use
EDAT- 2018/06/28 06:00
MHDA- 2018/06/28 06:01
PMCR- 2018/06/18
CRDT- 2018/06/28 06:00
PHST- 2016/11/14 00:00 [received]
PHST- 2018/06/11 00:00 [accepted]
PHST- 2018/06/28 06:00 [entrez]
PHST- 2018/06/28 06:00 [pubmed]
PHST- 2018/06/28 06:01 [medline]
PHST- 2018/06/18 00:00 [pmc-release]
AID - 109 [pii]
AID - 10.1186/s12962-018-0109-8 [doi]
PST - epublish
SO  - Cost Eff Resour Alloc. 2018 Jun 18;16:24. doi: 10.1186/s12962-018-0109-8. 
      eCollection 2018.