A Systematic Review and Meta-Analysis of Health Care Utilization Outcomes in Alcohol Screening and Brief Intervention Trials
Open accessAbstract
OBJECTIVE: This systematic review and meta-analysis examines the effect of screening and brief intervention (SBI) on outpatient, emergency department (ED), and inpatient health care utilization outcomes. Much of the current literature speculates that SBI provides cost savings through reduced health care utilization, but no systematic review or meta-analysis examines this assertion. METHOD: Publications were abstracted from online journal collections and targeted Web searches. The systematic review included any publications that examined the association between SBI and health care utilization. Each publication was rated independently by 2 study authors and assigned a consensus methodological score. The meta-analysis focused on those studies examined in the systematic review, but it excluded publications that had incomplete data, low methodological quality, or a cluster-randomized design. RESULTS: Systematic review results suggest that SBI has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization. A random effects meta-analysis using the Hedges method confirms the ED result for SBI delivered across settings (standardized mean difference = -0.06, I = 13.9%) but does not achieve statistical significance (confidence interval: -0.15, 0.03). CONCLUSIONS: SBI may reduce overall health care costs, but more studies are needed. Current evidence is inconclusive for SBI delivered in ED and non-ED hospital settings. Future studies of SBI and health care utilization should report the estimated effects and variance, regardless of the effect size or statistical significance.
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SBIRT has been shown to reduce health care costs by $366 per month per member.
“It has been shown to reduce health care costs by $366 per month per member,17 reduce emergency department use,18 and reduce rates of substance use by 67.7% and heavy alcohol use by 38.6% from baseline to 6 months, with significant improvements in general health and well‐being.19”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [17]
The Abstract Conclusions say SBI may reduce overall health care costs, but more studies are needed. The Discussion > Meta-Analysis describes the utilization effects as small and statistically insignificant. Our copy does not report a $366-per-member-per-month saving, and it does not establish the cost reduction as a demonstrated result. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe Alcohol Use Disorders Identification Test has high internal consistency and validity in a variety of populations.
“It has high internal consistency and validity in a variety of populations.17”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [17]
The Methods section assesses the methodological quality of brief-intervention studies, and the Results section reports health care utilization outcomes. Neither addresses the Alcohol Use Disorders Identification Test’s internal consistency or validity across populations; searches for the test’s name and for AUDIT reliability and validation found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPrior reviews have not provided enough evidence to determine whether brief alcohol interventions increase later treatment use.
“Overall, reviews have produced insufficient evidence to evaluate whether or not brief alcohol interventions actually increase subsequent treatment utilization.”
Two other systematic reviews examined the effect of brief interventions on later healthcare use, but neither specifically examined specialty alcohol treatment use.
“Two other systematic reviews (including one meta-analysis) evaluated the effect of brief interventions on subsequent healthcare utilization (i.e. inpatient, outpatient, and emergency care), but neither specifically examined utilization of specialty alcohol treatments (31,32).”
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References 53 · Cited by 65
Research works printed but not linked: 5
- [13]Solberg LI Maciosek MV Edwards NM Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness Am J Prev Med 2008 34 2 143 152 18201645
- [16]Latimer N Guillaume L Goyder E Chilcott J Payne N Prevention and Early Identification of Alcohol Use Disorders in Adults and Young People: Screening and Brief Interventions: Cost Effectiveness Review Sheffield ScHARR Public Health Collaborating Centre 2009
- [19]Fleming MF Barry KL Manwell LB Johnson K London R Brief physician advice for problem alcohol drinkers JAMA 1997 277 1039 1045 9091691
- [33]Lipsey MW Wilson DB Practical Meta-analysis Thousand Oaks Sage Publications 2001
- [37]Tomson Y Romelsjo A Aberg H Excessive drinking-brief intervention by a primary care nurse Scand J Prim Health Care 1998 16 188 192 9800234
- Authors
- Bray, J. W., Cowell, A. J., & Hinde, J. M.
- Affiliations
- RTI International (US)
- Venue
- Medical Care
- Published
- 2011-03
- Volume
- 49
- Issue
- 3
- Pages
- 287-294
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC4691530
- OpenAlex
- W1983435255
- Cited by
- 65
- References
- 53
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 10 · 2014: 5 · 2013: 8 · 2012: 5
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) (submittedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (R01AA013925)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- screening and brief intervention, alcoholism, health care utilization, emergency department utilization, outpatient care utilization, inpatient utilization, cost reduction, alcohol screening
- MeSH terms
- Alcohol Drinking, Alcoholism, Counseling, Delivery of Health Care, Humans, Treatment Outcome
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