Brief interventions to address substance use among patients presenting to emergency departments in resource poor settings: a cost-effectiveness analysis
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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)
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Dwommoh et al. conducted a cost-effectiveness analysis of MI intervention compared to MI-PST and Control and found that MI or MI-PST delivered by lay counsellors were cost-effective strategies for reducing SUD for emergency department patients compared to a control condition.
“Dwommoh et al. [116] conducted a cost-effectiveness analysis of MI intervention compared to MI-PST and Control and found that MI or MI-PST delivered by lay counsellors were cost-effective strategies for the reducing SUD for emergency department patients compared to a control condition (leaflet providing information on the effects of substance use) [116].”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [116]
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Experimental — accuracy not yet measuredTwo studies conducted a cost-effectiveness analysis of BI in Uganda and South Africa.
“Two studies conducted a cost-effectiveness analysis of BI in Uganda [115] and South Africa [116]).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [116]
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Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267 · see citing works
Methods for the Economic Evaluation of Health Care Programmes
Drummond, M. E., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (2005) · doi:10.1093/oso/9780198529446.001.0001 · Cited by 13,648 · see citing works
Problem solving and behavior modification.
D'Zurilla, T. J., & Goldfried, M. R. (1971) · Journal of Abnormal Psychology · doi:10.1037/h0031360 · Cited by 2,257 · see citing works
Human resources for mental health care: current situation and strategies for action
Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., Saxena, S., & Scheffler, R. M. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61093-3 · Cited by 979 · see citing works
Weinstein, M. C., Torrance, G. W., & McGuire, A. J. (2009) · Value in Health · doi:10.1111/j.1524-4733.2009.00515.x · Cited by 750 · see citing works
(2010) · Cited by 476 · see citing works
HERMAN, A. A. B., Stein, D. J., Seedat, S., Heeringa, S. G., Moomal, H., & Williams, D. R. (2009) · PubMed · Cited by 438 · see citing works
Self-citationNezu, A. M. (2002) · Springer eBooks · doi:10.1007/978-1-4615-0567-9_9 · Cited by 294 · see citing works
Gentilello, L. M., Ebel, B. E., Wickizer, T. M., Salkever, D. S., & Rivara, F. P. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000157133.80396.1c · Cited by 293 · see citing works
Lifetime prevalence of psychiatric disorders in South Africa
Stein, D. J., Seedat, S., HERMAN, A. A. B., Moomal, H., Heeringa, S. G., Kessler, R. C., & Williams, D. R. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.029280 · Cited by 287 · see citing works
Self-citationA systematic review of emergency care brief alcohol interventions for injury patients.
Nilsen, P., Baird, J., Mello, M. J., Nirenberg, T., Woolard, R., Bendtsen, P., & Longabaugh, R. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2007.09.008 · Cited by 207 · see citing works
Cost-Effectiveness Thresholds: the Past, the Present and the Future
Thokala, P., Ochalek, J., Leech, A. A., & Tong, T. (2018) · PharmacoEconomics · doi:10.1007/s40273-017-0606-1 · Cited by 206 · see citing works
Economic evaluation of a task-shifting intervention for common mental disorders in India
Buttorff, C., Hock, R., Weiss, H., Naik, S., Araya, R., Kirkwood, B., Chisholm, D., & Patel, V. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.12.104133 · Cited by 175 · see citing works
Petersen, I., Lund, C., Bhana, A., Flisher, A. J., & the Mental Health and Poverty Research Programme Consortium (2012) · Health Policy and Planning · doi:10.1093/heapol/czr012 · Cited by 158 · see citing works
Barrett, B. M., Byford, S., Crawford, M., Patton, R., Drummond, C., Henry, J. A., & Touquet, R. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.05.015 · Cited by 102 · see citing works
Information Created to Evade Reality (ICER)
Birch, S., & Gafni, A. (2006) · PharmacoEconomics · doi:10.2165/00019053-200624110-00008 · Cited by 96 · see citing works
Kunz, F. M., French, M. T., & Bazargan-Hejazi, S. (2004) · Journal of Studies on Alcohol · doi:10.15288/jsa.2004.65.363 · Cited by 89 · see citing works
The cost of harmful alcohol use in South Africa
Matzopoulos, R., Truen, S., Bowman, B., & Corrigall, J. (2013) · South African Medical Journal · doi:10.7196/samj.7644 · Cited by 88 · see citing works
Sorsdahl, K., Stein, D. J., Corrigall, J., Cuijpers, P., Smits, N., Naledi, T., & Myers, B. (2015) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/s13011-015-0042-1 · Cited by 84 · see citing works
Self-citationSelecting a decision model for economic evaluation: a case study and review
Karnon, J. D., & Brown, J. (1998) · Health Care Management Science · doi:10.1023/a:1019090401655 · Cited by 80 · see citing works
Neighbors, C. J., Barnett, N. P., Rohsenow, D. J., Colby, S. M., & Monti, P. M. (2010) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2010.71.384 · Cited by 76 · see citing works
Meade, C. S., Towe, S. L., Watt, M. H., Lion, R. R., MYERS, B. J., Skinner, D. G., Kimani, S., & Pieterse, D. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.04.016 · Cited by 62 · see citing works
Self-citationMYERS, B. J., Kline, T., Doherty, I. A., Carney, T., & Wechsberg, W. M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-100 · Cited by 49 · see citing works
Self-citationMyers, B., Stein, D. J., Mtukushe, B., & Sorsdahl, K. (2012) · Advances in Preventive Medicine · doi:10.1155/2012/569153 · Cited by 43 · see citing works
Self-citationFeasibility of Alcohol Screening and Brief Intervention
Schermer, C. R. (2005) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000174679.12567.7c · Cited by 37 · see citing works
Drug and alcohol services in middle-income countries
Perngparn, U., Assanangkornchai, S., Pilley, C., & Aramrattana, A. (2008) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e3282fc1ea3 · Cited by 28 · see citing works
Cowell, A. J., Brown, J. M., Mills, M. J., Bender, R. H., & Wedehase, B. J. (2012) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2012.73.226 · Cited by 27 · see citing works
Cowell, A. J., Bray, J. W., Mills, M. J., & Hinde, J. M. (2010) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2010.00238.x · Cited by 24 · see citing works
Handling Uncertainty in the Results of Economic EvaluationPreprint
Briggs, A. H. (1995) · RePEc: Research Papers in Economics · Cited by 19 · see citing works
MYERS, B. J., & Sorsdahl, K. R. (2015) · Addicta The Turkish Journal on Addictions · doi:10.15805/addicta.2014.1.2.023 · Cited by 13 · see citing works
Self-citation
Flagged first, then by citations
1 of the 31 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
van Ginneken, N., Chin, W. Y., Lim, Y. C., Ussif, A., Singh, R. K., Shahmalak, U., Purgato, M., Rojas‐García, A., Uphoff, E., McMullen, S., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub3 · Cited by 195 · see citing works
Wagenaar, B. H., Hammett, W. H., Jackson, C., Atkins, D. L., Belus, J. M., & Kemp, C. G. (2020) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2020.1 · Cited by 73 · see citing works
Werner, K., Risko, N., Burkholder, T. W., Munge, K., Wallis, L. A., & Reynolds, T. A. (2020) · Bulletin of the World Health Organization · doi:10.2471/blt.19.241158 · Cited by 42 · see citing works
Catma, S., & Reindl, D. M. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1919453 · Cited by 27 · see citing works
Staton, C. A., Friedman, K., Phillips, A. J., Minnig, M. C., Sakita, F. M., Ngowi, K. M., Suffoletto, B., Hirshon, J. M., Swahn, M., Mmbaga, B. T., et al. (2023) · PLOS ONE · doi:10.1371/journal.pone.0288458 · Cited by 14 · see citing works
van der Westhuizen, C., Malan, M., Naledi, T., Roelofse, M., Myers, B., Stein, D. J., Lahri, S., & Sorsdahl, K. (2021) · Addiction Science & Clinical Practice · doi:10.1186/s13722-021-00239-5 · Cited by 13 · see citing works
Self-citationMutyambizi-Mafunda, V., MYERS, B. J., Sorsdahl, K. R., Chanakira, E., Lund, C., & Cleary, S. (2022) · Health Policy and Planning · doi:10.1093/heapol/czac069 · Cited by 14 · see citing works
Self-citationGoldstone, D., Bantjes, J. R., Nel, D. G., Stanbridge, J. A., & Lewis, I. (2020) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2019.1711419 · Cited by 11 · see citing works
Curtis, K. A., Qian, S., Yu, P., White, J., Ruperto, K., Balzer, S., & Munroe, B. (2020) · Australasian Emergency Care · doi:10.1016/j.auec.2020.04.002 · Cited by 11 · see citing works
A scoping review of substance use brief interventions in Africa
Jaguga, F., Kiburi, S. K., Temet, E., Aalsma, M. C., Ott, M. A., Maina, R. W., Wachira, J., Mostert, C., Kosgei, G., Tenge, A., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003340 · Cited by 10 · see citing works
Mutyambizi-Mafunda, V., MYERS, B. J., Sorsdahl, K. R., Lund, C., Naledi, T., & Cleary, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026973 · Cited by 10 · see citing works
Self-citationAssessment of substance use among injured persons seeking emergency care in Nairobi, Kenya
Lee, J. A., Ochola, E., Sugut, J., Ngila, B., Ojuka, D. K., Mello, M. J., & Aluisio, A. R. (2022) · African Journal of Emergency Medicine · doi:10.1016/j.afjem.2022.06.011 · Cited by 5 · see citing works
Addressing the substance use treatment gap in Africa using digital screening and brief interventions
Jaguga, F., Kwobah, E. K., Barasa, J., Mwogi, T., & Giusto, A. M. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00096-7 · Cited by 2 · see citing works
Olaoluwa, A. A., Masta, M. A., Fawole, H. O., Atama, T., Bulama, M. T. A., Alumona, C. J., Kolawole, F. O., & Akinrolie, O. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70137 · Cited by 1 · see citing works
Motivational Interviewing and Quality Improvement Research
Choflet, A., Lavezza, A., & Daley, K. N. (2024) · doi:10.1093/oso/9780197748268.003.0014 · Cited by 1 · see citing works
Bala, S., & Kang’ethe, S. M. (2022) · African Journal of Drug and Alcohol Studies · doi:10.4314/ajdas.v20i1.1
Bond, S., & Mashambanhaka, P. (2022) · SOUTHERN AFRICAN JOURNAL OF SOCIAL WORK AND SOCIAL DEVELOPMENT · doi:10.25159/2708-9355/9985
Pereira‐Morales, A. J., Ramírez-Cortázar, F., Mayorga, M. F. R., & Eslava-Schmalbach, J. H. (2024) · Current Psychology · doi:10.1007/s12144-024-06799-4
Austin Lee, J., Timmy, L., Janette, B., Beatrice, N., Sugut, J., Kinuthia, J., Waweru, H., Daniel, K. O., Michael, J. M., & Aluisio, A. R. (2026) · Journal of Clinical Research in HIV AIDS and Prevention · doi:10.14302/issn.2324-7339.jcrhap-26-6137
- Authors
- Dwommoh, R., Sorsdahl, K., Myers, B., Asante, K. P., Naledi, T., Stein, D. J., & Cleary, S.
- Affiliations
- University of Cape Town (ZA)
- South African Medical Research Council (ZA)
- Kintampo Health Research Centre (GH)
- Western Cape Department of Health (ZA)
- Corresponding author
- Dwommoh, Rebecca
- ORCID
- Venue
- Cost Effectiveness and Resource Allocation
- Published
- 2018-06-18
- Volume
- 16
- Issue
- 1
- Pages
- 24-24
- ISSN
- 1478-7547 (ISSN-L)
- PMC
- PMC6006568
- OpenAlex
- W2808248694
- Cited by
- 21
- References
- 31
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 1 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 1
- FWCI
- 1.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cost Effectiveness and Resource Allocation (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open University of Cape Town (University of Cape Town) (submittedVersion)
- Funders
- Department of Health of the Western Cape Government (Not Applicable)
- 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
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- brief intervention, substance use disorders, motivational interviewing, problem-solving therapy, emergency department patients, resource-limited settings, cost-effectiveness, alcohol consumption, smoking, depression, lay counselors, South Africa, ASSIST, CES-D, out-of-pocket costs, screening and referral, implementation barriers and facilitators
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