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Cited by 28Substance Abuse Treatment and OutcomesHealth Systems, Economic Evaluations, Quality of LifeEmergency and Acute Care Studies

Cost of screening, brief intervention, and referral to treatment in health care settings

Open access
Barbosa, Carolina, Cowell, Alexander J., Landwehr, Justin, Dowd, William, Bray, Jeremy W.·2016·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2015.06.005
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Abstract

Aims This study analyzed service unit and annual costs of substance abuse screening, brief intervention, and referral to treatment (SBIRT) programs implemented in emergency department (ED), inpatient, and outpatient medical settings in three U.S. states and one tribal organization.Methods Unit costs and annual costs were estimated from the perspective of service providers. Data for unit costs came from 26 performance sites, and data for annual costs came from 10 programs. A bottom-up approach was used to derive unit costs and included labor, space, and materials used in each SBIRT activity. Activities included direct SBIRT services and activities that support direct service delivery. Labor time spent in each activity was collected by trained observers using a time-and-motion approach. A top-down approach used cost questionnaires completed by program administrators to calculate annual costs and included labor, space, contracted services, overhead, training, travel, equipment, and supplies and materials. Costs were estimated in 2012 U.S. dollars.Results Average unit costs for prescreening, screening, brief intervention, brief treatment, and referral to treatment were $0.61, $6.59, $10.48, $22.63, and $12.06 in ED; $0.86, $6.33, $9.07, $27.61, and $8.03 in inpatient; and $0.84, $3.98, $7.81, $27.94, and $9.23 in outpatient settings, respectively; over half of the costs were attributable to support activities. Across all settings, the average cost to provide SBIRT per positive screen, for 1year, was about $400.Conclusions Support activities comprise a large proportion of costs. Health administrators can use the results to budget and compare how much sites are reimbursed for SBIRT to how much services actually cost.

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  • Across all settings, the average cost per episode of brief treatment is $31, ranging from $27 to $33 per session.

    “Across all settings, the average cost per episode of brief treatment (BT) is $31, ranging from $27 to $33 per session.”

    From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Barbosa, Cowell, Landwehr, Dowd, & Bray, 2016

    Section 3.1 (Unit costs, including Table 2) gives an average brief-treatment unit cost of $26.06 across settings, with setting-specific averages of $22.63, $27.61, and $27.94. The Discussion repeats the $26.06 overall figure. These figures do not match the claimed $31 average or $27–$33 range. (LLM, conf=0.90)

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  • Referral to treatment is less resource intensive than brief intervention or brief treatment, with an average cost of $12 and a range of $9.58 to $14.

    “Referral to treatment is less resource intensive than BI or BT, with an average cost of $12 (range $9.58 to $14).”

    From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Barbosa, Cowell, Landwehr, Dowd, & Bray, 2016

    Section 3.1 (page unavailable) reports a lower average unit cost for referral to treatment ($7.83) than for brief intervention ($8.56) or brief treatment ($26.06). It does not support the claimed $12 average or $9.58–$14 range; its setting-specific referral costs are $8.03, $9.23, and $12.06. The Discussion also cautions that referrals were rarely observed, limiting strong conclusions about their costs. (LLM, conf=0.88)

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  • Some measures, such as substance use disorder treatment episode costs, are based on detailed micro-costing studies that most accurately reflect the opportunity cost of program resources.

    “Some measures, such as SUD treatment episode costs, are based on detailed micro-costing studies that most accurately reflect the opportunity cost of program resources (Alexandre et al., 2012; Barbosa et al., 2016; Bray et al., 2012; Popovici, French, & McKay, 2008).”

    From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Barbosa et al., 2016

    Section 2.1 (Overview; page unavailable) describes detailed microcosting of SBIRT service-unit costs, and section 4 (Discussion; page unavailable) says the resources were valued at their opportunity cost. The paper does not estimate SUD treatment episode costs or establish that these estimates most accurately reflect the opportunity cost of program resources. (LLM, conf=0.88)

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Authors
Barbosa, C., Cowell, A. J., Landwehr, J., Dowd, W., & Bray, J. W.
Affiliations
  • RTI International (US)
  • University of North Carolina at Greensboro (US)
Corresponding author
Barbosa, Carolina
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2016-01
Volume
60
Pages
54-61
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2015.06.005
OpenAlex
W879976279
Cited by
28
References
43
Citations by year
2026: 2 · 2025: 1 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 1 · 2015: 1
FWCI
2.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) (submittedVersion)
Funders
  • U.S. Department of Health and Human Services
  • American College of Surgeons
  • U.S. Public Health Service (HHSS283200700002I)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
SBIRT, cost analysis, unit cost, emergency department, inpatient settings, outpatient settings, substance use screening, support activities, health care budgeting, reimbursement
MeSH terms
Delivery of Health Care, Government Programs, Humans, Referral and Consultation, United States, United States Substance Abuse and Mental Health Services Administration, Substance-Related Disorders

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