UW News

January 14, 2005

Alcohol screening and intervention in the trauma setting save health-care costs by preventing further injuries

Brief alcohol counseling sessions for injured patients, already shown to be effective in reducing subsequent alcohol intake and trauma recidivism, can also reduce health-care costs. Each dollar spent on alcohol screening and intervention saves $3.81 in health expenditures, according to a new study by researchers at the University of Texas Southwestern Medical Center at Dallas, the Harborview Injury Prevention & Research Center, and the Johns Hopkins University School of Public Health.

“Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis” was published on-line today and will be the featured article in the April issue of the Annals of Surgery. (For obtain a faxed copy of the article now, contact Larry Zalin at 206-744-9459.)

Alcohol intoxication has been found to be the leading risk factor for injury, according to previous research. Of the estimated 20.5 million American adults requiring emergency department (ED) care for their injuries, 27 percent screened positive for alcohol intoxication or dependency. A 30-minute intervention with a trained counselor has been shown to be highly effective at reducing subsequent alcohol use, injuries, and visits to the ED or hospital.

This study is the first to estimate the cost savings associated with the routine provision of brief alcohol interventions to trauma patients treated in hospitals and EDs. If a brief intervention were offered to every eligible injured person in the U.S., the resulting savings from health-care costs alone would be approximately $182 billion annually (20.5 million adult trauma patients multiplied by $89 of health-care cost savings per patient screened).

If injured patients were screened for alcohol problems and the brief intervention offered to those who qualify, the expected cost of screening, intervention, and subsequent ED visits and hospital admissions over the next three years was $600 per patient. When the screening and intervention were not offered, the expected cost of subsequent ED visits and hospital care was $689 per patient over three years. The brief intervention resulted in $3.81 in health-care savings for every dollar spent on screening and intervention.

“This study indicates that routine alcohol screening and intervention for trauma patients result in reduced health-care costs,” says Larry Gentilello, M.D., a professor of surgery at the University of Texas Southwestern Medical Center at Dallas and principal investigator for the study. “These intervention capitalize on a ‘teachable moment,’ during which the health-care worker can help a patient understand the link between their drinking and its consequences at a time when these consequences are obvious. Alcohol interventions in trauma centers may also provide an opportunity to initiate care before alcohol problems progress to a more severe stage, requiring more costly and intensive treatment and medical services.”

Changes in health-care financing will be required before implementation of screening and intervention programs in trauma centers, the researchers say. Since 1947, most states have allowed insurance companies to deny payment on a claim in which an individual was injured and alcohol use was documented. This has been found to be a deterrent to alcohol screening in hospitals and emergency departments.

The National Association of Insurance Commissioners recently passed a model law that disallows such denials. The National Conference of Insurance Legislators has recommended that states adopt this model, but such changes must be adopted by individual state legislatures. Several states, including Washington, have recently done so.

In addition to Gentilello, the study was conducted by Beth Ebel, M.D., M.P.H., an assistant professor of pediatrics at the University of Washington (UW); Thomas Wickizer, Ph.D., M.P.H., a professor of health services and community medicine at the UW; David Salkever, Ph.D., a professor of health policy and management at the Johns Hopkins University School of Public Health; and Frederick Rivara, M.D., M.P.H., a professor of pediatrics and adjunct professor of epidemiology at the UW.

The research was supported by a grant from the Robert Wood Johnson Foundation.