Aims To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers.
Design Cost-effectiveness analysis based on a randomized controlled trial. Setting New Haven, CT, USA.
Participants A convenience sample of 439 women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication.
Interventions Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145).
Measurements The primary outcome was days of primary substance abstinence during the six-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the six-month follow-up period, we also considered the number of days of abstinence from all substances. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves determined the relative cost-effectiveness of the three conditions from both the clinic and patient perspectives.
Findings From a health-care provider perspective, e-SBIRT is likely (with probability greater than 0.5) to be cost-effective for any willingness-to-pay value for an additional day of primary-substance abstinence and an additional day of all-substance abstinence. From a patient perspective, EUC is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is less than $0.18 and e-SBIRT is most likely to be the cost-effective intervention when thewillingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18.
Conclusions e-SBIRTc ould be a cost-effective approach, fromboth health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.