Health Care and Health Policy

To combat the COVID-19 crisis, health systems leaders need a clear, systematic approach to quickly evaluate critical needs and identify areas of weakness. In addition, to flatten the curve of the rates of infection and hospitalization, health systems need to proactively deploy a robust preparedness strategy. This compilation of best practices for COVID-19 preparedness is based on established guidelines and firsthand experiences on the front lines of the COVID-19 pandemic. The cornerstones of an effective COVID-19 preparedness plan for a health system are: (1) mitigating local transmission; (2) conserving, supporting, and protecting staff; (3) eliminating nonurgent strains on the system; and (4) coordinating communication. Health systems should not wait until they face a surge in COVID-19 cases to implement a comprehensive response. By acting early, health systems may avoid being crippled by crisis and continue to be operational and provide critically important care.

This Policy Research Project (PRP) analyzes how Austin-Travis County Emergency Medical Services (ATCEMS) could better integrate with local healthcare networks to support patient-centered, effective, out-of-hospital care. For nine months, the PRP team reviewed relevant innovations around the nation. With input provided by ATCEMS and the Office of the Medical Director, the group identified seven innovations that have the potential to be impactful in Austin's changing environment. This report provides program descriptions, cost and impact estimates, and possible implementation strategies for each of the seven innovations studied.

Objective
To determine the relative cost-effectiveness of individual female-specific cognitive behavioral therapy (I-FS-CBT) versus group female-specific cognitive behavioral therapy (G-FS-CBT).

Methods
This cost-effectiveness study is based on a randomized controlled trial in which 155 women seeking treatment for alcohol use disorder at an academic outpatient clinic were randomized to 12 manual-guided sessions of I-FS-CBT (n = 75) or G-FS-CBT (n = 80). The primary patient outcomes were the number of drinking days and the number of heavy drinking days during the 12-week treatment and 1-year follow-up periods. All cost data (including resource utilizations) were collected prospectively alongside the trial. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to determine the cost-effectiveness of I-FS-CBT relative to G-FS-CBT. Results are presented from the provider perspective.

Results
During the 12-week treatment period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $141 (or $258), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $141 (or $258). During the 1-year follow-up period, G-FS-CBT is likely to be cost-effective when the threshold value to decision-makers of one fewer drinking day (or one fewer day of heavy drinking) is less than $54 (or $169), and I-FS-CBT is likely to be cost-effective if the threshold is greater than $54 (or $169). The results are robust to sensitivity analyses on several key cost parameters.

Conclusions
Compared to I-FS-CBT, G-FS-CBT holds promise as a cost-effective approach, in both the short run and the long run, for improving drinking outcomes of women with alcohol use disorder.

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.