The Cost-Effectiveness and Cost-Benefit of Screening and Brief Intervention for Unhealthy Alcohol Use in Medical Settings Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. A randomized controlled trial of a behavioral economic supplement to brief motivational interventions for college drinking. Economic Analysis of Health Care Technology: A Report on Principles A Qualitative Investigation of Organizational Issues in an Alcohol Awareness Program for Blue-Collar Workers Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions Alcoholism treatment and medical care costs from Project MATCH. Economic evaluation of a workplace intervention for sick-listed employees with distress Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial The impact of school alcohol policy on student drinking. The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol An evaluation of two primary care interventions for alcohol abuse among Mexican-American patients. Healthy public policy A conceptual cognitive framework. Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Economic evaluation of a task-shifting intervention for common mental disorders in India. Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients Challenges applying alcohol brief intervention in diverse practice settings: populations, outcomes, and costs.
SUMMARY Economic evaluation can be a valuable tool for assessing the efficiency and value of health care programs . To examine the literature on the economic evaluation of  alcohol screening and brief intervention in medical setting s , relevant studies were identified in the MEDLINE data base ( 1966 through November 2006 ) and by h and - search ing the references of identified articles and relevant journals . The 15 identified studies used a range of economic evaluation methods , including cost analysis , cost-benefit , cost-effectiveness , and cost-utility . Nearly all of the studies supported the use of alcohol screening and brief intervention . The studies that prospect ively collected cost and effect data and /or conformed closely to method ological guidelines demonstrated a strong economic benefit of alcohol screening and brief intervention when compared to usual care . Overall , the review ed studies support alcohol SBI in medical setting s as a wise use of health care re sources and illustrate the usefulness of economic evaluation for assessing alcohol prevention and treatment programs BACKGROUND Few studies have estimated the economic costs and benefits of brief physician advice in managed care setting s. OBJECTIVE To conduct a benefit-cost analysis of brief physician advice regarding problem drinking . DESIGN Patient and health care costs associated with brief advice were compared with economic benefits associated with changes in health care utilization , legal events , and motor vehicle accidents using 6- and 12-month follow-up data from Project TrEAT ( Trial for Early Alcohol Treatment ) , a r and omized controlled clinical trial . SUBJECTS 482 men and 292 women who reported drinking above a threshold limit were r and omized into control ( n = 382 ) or intervention ( n = 392 ) groups . MEASURES Outcomes included alcohol use , emergency department visits , hospital days , legal events , and motor vehicle accidents . RESULTS No significant differences between control and intervention subjects were present for baseline alcohol use , age , socioeconomic status , smoking , depression or anxiety , conduct disorders , drug use , crimes , motor vehicle accidents , or health care utilization . The total economic benefit of the brief intervention was $ 423,519 ( 95 % CI : $ 35,947 , $ 884,848 ) , composed of $ 195,448 ( 95 % CI : $ 36,734 , $ 389,160 ) in savings in emergency department and hospital use and $ 228,071 ( 95 % CI : -$191,419 , $ 757,303 ) in avoided costs of crime and motor vehicle accidents . The average ( per subject ) benefit was $ 1,151 ( 95 % CI : $ 92 , $ 2,257 ) . The estimated total economic cost of the intervention was $ 80,210 , or $ 205 per subject . The benefit-cost ratio was 5.6:1 ( 95 % CI : 0.4 , 11.0 ) , or $ 56,263 in total benefit for every $ 10,000 invested . CONCLUSIONS These results offer the first quantitative evidence that implementation of a brief intervention for problem drinkers can generate positive net benefit for patients , the health care system , and society OBJECTIVE Behavioral economic theory suggests that a reduction in substance use is most likely when there is an increase in rewarding substance-free activities . The goal of this r and omized controlled clinical trial was to evaluate the incremental efficacy of a novel behavioral economic supplement ( Substance-Free Activity Session [ SFAS ] ) to a st and ard alcohol brief motivational interviewing ( BMI ) session for heavy-drinking college students . METHOD Participants were 82 first-year college students ( 50 % female ; 81.7 % White/European American ; M age = 18.5 years , SD = 0.71 ) who reported 2 or more past-month heavy drinking episodes . After completing a baseline assessment and an individual alcohol-focused BMI , participants were r and omized to either the SFAS or to a Relaxation Training ( RT ) control session . The SFAS was delivered in an MI style and attempted to increase the salience of delayed academic and career rewards and the patterns of behavior leading to those rewards . RESULTS The combination of an alcohol BMI plus the SFAS was associated with significantly greater reductions in alcohol problems compared with an alcohol BMI plus RT at the 1-month and 6-month follow-up assessment s ( p = .015 , ηp² = .07 ) , an effect that was partially mediated by increases in protective behavioral strategies . BMI + SFAS was also associated with greater reductions in heavy drinking among participants who at baseline reported low levels of substance-free reinforcement or symptoms of depression . CONCLUSION These results are consistent with behavioral economic theory and suggest that a single session focused on increasing engagement in alternatives to drinking can enhance the effects of brief alcohol interventions Preamble Although economic outcomes research is an evolving field in health services research , there are correct and incorrect ways to conduct and report on economic outcomes studies . Research practice s that help to minimize real or perceived bias will increase the quality and usefulness of such studies for those who sponsor , publish , and use them . Because of public concerns about the potential for bias in the design , analysis , and reporting of economic analyses of health care technology , we formed a task force to develop principles to enhance the credibility of these studies . The Task Force on Principles for Economic Analysis of Health Care Technology included participants from academia , the pharmaceutical industry , the public sector , and private research organizations . As health care re sources become increasingly constrained , the information used to make re source allocation decisions must be as reliable , valid , and free of bias as possible . Getting it right at the level at which economic results are produced will help to protect consumers and will advance the health of the public . Bias stems from two broad categories : lack of appropriate independence for research ers and lack of consensus about methods . We focused heavily on the first of these categories for two major reasons . First , few have yet considered the unique issues of research er independence in economic outcomes research [ 1 , 2 ] . Second , other investigators have begun to consider and define proper methods for economic outcomes work ( an area of considerable controversy ) [ 3 - 5 ] . We also looked closely at the requirements for the reporting of economic analyses , which are intended to ensure method ologic transparency and accountability . The Need for Voluntary Guidelines Widespread use of economic analysis as part of the development of pharmaceutical , biotechnologic , and medical devices is relatively new . To date , many economic analyses of health care have focused on pharmaceutical agents , and many such studies have been funded by pharmaceutical companies . Results of these economic outcomes studies are used by medical technology firms to support the pricing and marketing of new interventions and to influence national health care systems and third-party payers in their development of coverage and payment decisions . Managed care organizations , hospitals , and government-subsidized health care programs rely on economic analysis of medical technology to help make formulary purchasing and utilization decisions . Physicians may use the results of these analyses to help guide treatment and prescription decisions . Health care economic outcomes projects are sponsored and conducted by pharmaceutical , biotechnologic , and medical device companies ; government agencies ; nonprofit foundations ; academic investigators ; and private research and consulting firms . The st and ards and methods used to evaluate the safety and efficacy of pharmaceutical products in r and omized , controlled trials have evolved over 50 years of collaboration among research ers in private , public , and academic setting s. Compared with those established to ensure the safety and efficacy of clinical trials , the principles and methods for the conduct of economic studies of health care technology are far less developed . Problems of conduct , reporting , and bias exist in all types of research [ 6 - 14 ] . In response , codes of conduct , such as those developed by the American Federation for Clinical Research and the Institute of Medicine , have been developed for many scientific disciplines [ 15 - 24 ] . These are good models on which to base principles of conduct for economic outcomes analysis . Although many published principles apply to economic studies , others should be modified and new ones should be developed to guide the conduct and reporting of economic outcomes analyses . Economic outcomes research requires unique guidelines for the following reasons : 1 ) As a field , it continues to evolve and is often misunderstood by end users ; 2 ) peer review of it requires special expertise that often exceeds the capabilities of review ers and scientific journals ; 3 ) it often uses secondary data and requires that many assumptions be made [ for example , attribution of a dollar cost to a unit of re source use ] ; 4 ) it offers unique method ologic choices , such as which types of costs to include ( direct , indirect , intangible , induced ) , which perspective to apply ( that of society , payer , provider , patient ) , which design to adopt ( cost- identification , costbenefit , cost-effectiveness , costutility ) , from where to obtain costs [ indemnity data base , managed care or capitated data base , hospital cost systems , Medicare , Medicaid ] , and whether to collect re source consumption data prospect ively or retrospectively through various modeling techniques ; and 5 ) economic studies play an increasingly important role in health care decision making because of increasing financial constraints throughout the health care industry . The financial and medical implication s of decision making done on the basis of these studies , coupled with the lack of widely accepted guidelines about the conduct and reporting of economic analyses , undermine the credibility of this research . A major issue is that the primary source of funding for this research is often the primary financial beneficiary of positive study results . Unfortunately , even valid studies done under the best of circumstances may be suspect [ 25 - 29 ] . This has led at least one major journal to conclude that these analyses should be viewed much like editorials or review articles are viewed in terms of potential for conflicts of interest [ 30 ] . We developed the guidelines reported here after extensive consultation with experts from the public , private , and academic sectors . We recommend that research ers and sponsors adhere to these guidelines , and we suggest they state publicly within their manuscripts that they have done so . End users , including journal editors and readers , consumers , and social decision makers , may then feel more secure in accepting the results of the research , while recognizing that intensive critique of the research will always be necessary . Operations of the Task Force The Task Force on Principles for Economic Analysis of Health Care Technology was initiated and organized by faculty from the Leonard Davis Institute ( LDI ) Center for Health Policy of the University of Pennsylvania . However , because not all LDI faculty were involved , this paper does not represent an official LDI position statement . The Task Force was funded by a coalition of pharmaceutical companies ( Appendix A ) . Funding was also requested ( but not obtained ) from various government and private foundations . All funding was provided in the form of unrestricted research grants or gifts to the University of Pennsylvania . Guidelines derive their credibility in part from the composition of the panel that creates them and the process by which they are developed . C and i date s for participation in the Task Force from the private sector and the academic research community were identified by the frequency with which they were cited in the health economics literature , which was obtained using a MEDLINE search of literature related to economic analyses of medical technology published between 1983 and 1992 . Approximately 15 members attended each meeting . Minutes were distributed after each meeting and approved by all members present . Members from the sponsoring pharmaceutical companies and the academic organizers rotated so that they numbered three and one , respectively , at the table for each formal Task Force meeting . Several professional and governmental organizations , including the Institute of Medicine , the Agency for Health Care Policy and Research , the Food and Drug Administration ( FDA ) , the Health Care Financing Administration , the Centers for Disease Control and Prevention , and a managed care organization , were asked to suggest persons who might participate . In addition , other organizations with a stake in economic analyses were each asked to suggest a person who , because of his or her professional background , had extensive knowledge of or experience with economic analyses . An academic pharmacist , an academic research er , a private research er , an ethicist and patient advocate , and an attorney specializing in medical ethics rounded out the Task Force ( Appendix B ) . Two members withdrew from participation . A small audience consisting of industry sponsors , academic organizers , staff , and a few other interested parties were invited to each meeting and allowed to comment . Four formal meetings of the Task Force were held in Philadelphia during 1993 and 1994 , and the most substantial work was done by various subcommittees between these meetings . The three main subcommittees were titled Ethical Conduct , Responsibility and Control ( the findings of these two subcommittees were later merged into one report ) , and Reporting Requirements for Economic Evaluations ( Appendix C ) . The Task Force was assisted by a professional facilitator . Although Task Force members sought consensus wherever possible on the key issues , consensus was not forced and recommendations were issued only when substantial agreement existed among the members . Task Force members were not asked to formally represent any organization . Formal endorsement of the final document was not sought . Copies of this report will be distributed to all organizations that were asked to suggest a participant and to other parties who responded to announcements placed in The New Engl and Journal of Medicine , Scrip , and the Pink Sheet . The Task Force findings will also be reported at academic conferences , medical profession meetings , and appropriate trade conventions . Findings and Recommendations Valid approaches to economic analyses can be defined ; acceptable methods can be differentiated from unacceptable ones . Bias in economic research stems from two major sources : lack of appropriate independence for Purpose . To explore sociopolitical and organizational issues in worksite alcohol health promotion . Few such programs are reported in the literature . Design . Qualitative data were gathered during the development and implementation phases of a program through focus groups , key informant interviews , and observations made by the research team . Setting s and Subjects . One hundred and ninety-nine blue-collar workers from a private company ( a group which was also involved in a r and omized controlled trial ) and 123 workers from four other organizations ( nontrial groups ) received the intervention . The nontrial groups were used to pilot-test the intervention and in a post-trial assessment . All companies were located in Montreal , Quebec , Canada . Intervention . Two worksite health promotion sessions on responsible drinking were given to small groups of workers . Measures . The reactions of workers , unions , and employers to the program and to the evaluation trial were observed . The viewpoints of key informants were solicited through semi-structured interviews . Analysis was accomplished through several cycles of memo writing . Results . Alcohol is a sensitive subject when discussed in worksite group setting s. Our data suggest that there are alcohol problems in the workplace of which coworkers are clearly cognizant . In one setting the intervention led to the development of organizational rules regarding workers who reported to work inebriated , where this behavior had been previously tolerated . The sessions were better received when disease concepts were avoided . Evaluation research on alcohol requires particular care with confidentiality and ongoing communication with all stakeholders , especially unions . Conclusions . Worksite health promotion regarding alcohol is feasible . The complex process of negotiating , implementing , and evaluating a worksite alcohol health promotion program is discussed . More research on the sociopolitical aspects of such programs is needed Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. CRD42013005943 ) . Available at : http://www.crd.york.ac.uk/ prospero /display_record.asp?ID = CRD42013005943 AIMS This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality . DESIGN Longitudinal study with pre- and post-treatment initiation . MEASUREMENTS The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment . SETTING Three treatment sites at two of the nine Project MATCH locations ( Milwaukee , WI and Providence , RI ) . PARTICIPANTS Two hundred and seventy-nine patients . INTERVENTION Patients were r and omly assigned to one of three treatment modalities : a 12-session cognitive behavioral therapy ( CBT ) , a four-session motivational enhancement therapy ( MET ) or a 12-session Twelve-Step facilitation ( TSF ) treatment over 12 weeks . FINDINGS Total medical care costs declined from pre- to post-treatment overall and for each modality . Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings . However , patients with poor prognostic characteristics ( alcohol dependence , psychiatric severity and /or social network support for drinking ) have better cost-savings potential with CBT and /or TSF . CONCLUSIONS Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment Objectives To evaluate the cost effectiveness , cost utility and cost benefit of a workplace intervention compared with usual care for sick-listed employees with distress . Methods An economic evaluation was conducted alongside a r and omised controlled trial . Employees with distress and who were sick-listed for 2–8 weeks were r and omised to a workplace intervention ( n=73 ) or to usual care ( n=72 ) . The workplace intervention is a stepwise process involving the sick-listed employee and their supervisor , aim ed at formulating a consensus-based plan for return to work ( RTW ) . The effect outcomes were lasting RTW and quality -adjusted life years ( QALYs ) . Healthcare utilisation was measured over 12 months . Cost effectiveness analyses ( CEA ) and cost utility analyses ( CUA ) were conducted from the societal perspective and cost benefit analyses ( CBA ) from the employer perspective . Bootstrapping techniques were used to estimate cost and effect differences , related CIs , and cost effectiveness and cost utility ratios . Cost effectiveness planes were presented and subgroup analyses were performed . Results CEA and CUA revealed no statistically significant differences in lasting RTW , QALYs or costs . The CBA indicated a statistically significant higher cost of occupational health services in the workplace intervention group . The workplace intervention was not cost effective according to the CEA , CUA and CBA . Conclusions Widespread implementation of the workplace intervention for sick-listed employees with distress is not recommended because there was no economic benefit compared with usual care . Future trials should confirm if the workplace intervention is cost effective for the subgroup employees who intended to return to work despite symptoms . This trial has been registered at the Dutch National Trial Register IS RCT N92307123 Background The European level of alcohol consumption , and the subsequent burden of disease , is high compared to the rest of the world . While screening and brief interventions in primary healthcare are cost-effective , in most countries they have hardly been implemented in routine primary healthcare . In this study , we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement : training and support to address lack of knowledge and motivation in healthcare providers ; financial reimbursement to compensate the time investment ; and internet-based counselling to reduce workload for primary care providers . Methods / design In a cluster r and omized factorial trial , data from Catalan , English , Netherl and s , Polish , and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption . The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group . Screening and brief intervention activities will be measured at baseline , during 12 weeks and after six months . Process measures include health professionals ’ role security and therapeutic commitment of the participating providers ( SAAPPQ question naire ) . A total of 120 primary healthcare units will be included , equally distributed over the five countries . Both intention to treat and per protocol analyses are planned to determine intervention effectiveness , using r and om coefficient regression modelling . Discussion Effective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required . This international multi-centre trial will provide evidence to guide decision makers . Trial registration Clinical Trials.gov . Trial identifier : Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse , there has been little evaluation of the efficacy of these policies . The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative sample s of secondary students in Washington State , USA , and Victoria , Australia ( n = 1848 ) .  Multivariate logistic regressions were used to examine the prospect i ve association between student reports of school alcohol policy  in Grade 8 and self-reported alcohol use in Grade 9 , controlling for age , gender , state , family socio-economic status and Grade 8 alcohol use . The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement . Student perceptions of harm minimization alcohol messages , abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking . Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms . Perceptions of harsh penalties were unrelated to drinking behaviour . These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption . In older population s excessive alcohol consumption is associated with increased risk of coronary heart disease , hypertension , stroke and a range of cancers . Alcohol consumption is also associated with an increased risk of falls , early onset of dementia and other cognitive deficits . Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels . There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in population s identified opportunistically in primary care setting s. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially re source efficient means of meeting the needs of this population . Methods / design The study design is a pragmatic prospect i ve multi-centre two arm r and omised controlled trial . The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post r and omisation . Potential participants are identified using the AUDIT question naire . Eligible and consenting participants are r and omised with equal probability to either a minimal intervention or a three step treatment approach . The step treatment approach incorporates as step 1 behavioural change counselling , step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services . The primary outcome is measured using average st and ard drinks per day and secondary outcome measures include the Drinking Problems Index , health related quality of life and health utility . The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions . Discussion The paper presents a protocol for the first pragmatic r and omised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care . Trial registration IS RCT AIMS This study examined the effects of two primary care interventions ( a physician intervention and a clinic-based psychoeducational group ) on drinking patterns , psychosocial problems and blood test results ( MCV , GGT , SGOT and SGPT ) . DESIGN Subjects were r and omized into one of four treatment groups : physician intervention , psychoeducation , both interventions , or no intervention . Follow-up data were collected at 12 and 18 months . SETTING Subjects were recruited from a family practice outpatient clinic managed by a public hospital . PARTICIPANTS Included 175 Mexican-American female and male primary care patients who screened positive for alcohol abuse or dependence . These patients were not seeking help for alcohol problems . INTERVENTIONS Included a brief physician intervention and a 6-week patient psychoeducational group . MEASUREMENTS The Diagnostic Interview Schedule assessed subjects for alcohol abuse ; the Addiction Severity Index measured alcohol-related problems , including psychosocial issues . FINDINGS All four treatment groups demonstrated significant improvement over time , with few differences between intervention and control groups . CONCLUSIONS Assessment can be confounded with brief interventions ; future investigators should use non-assessed control groups More than three decades ago , the report A New Perspective on the Health of Canadians ( 1974 ) highlighted the significance of other determinants than the healthcare system . The adoption of healthy public policy was identified in the Ottawa Charter ( 1986 ) as one of five strategies aim ing to promote health . It must now be acknowledged that even if we have a better underst and ing of health determinants , the latter are not necessarily taken into consideration when developing public policies . The purpose of this paper is to help foster a better underst and ing of the healthy public policies by presenting a conceptual framework that is inspired by the Advocacy Coalition Framework developed by Sabatier and Jenkins-Smith ( 1999 ) . On the one h and , this paper intends to show the relevance of the notion of subsystem of public policies in healthy public policy process . On the other , it aims to convince that it is necessary to channel the analysis around the decision-making process , the prospect i ve evaluation of public policies and the knowledge transfer and appropriation process . Finally , the purpose of this paper is to contribute to the ongoing debate about the role of knowledge , values or beliefs in the formulation and adoption of public policies . After briefly summarizing the theoretical developments in studies on public policies , the logic and components of the ACF are introduced . The main criticisms regarding the ACF are then examined , followed by an introduction of the conceptual framework that is adapted to the reality of healthy public policies . The notions of the subsystem of public policy(ies ) , of process and of learning process are central to this framework OBJECTIVE Alcohol screening and brief intervention ( SBI ) has gained widespread acceptance as an effective method for reducing problem drinking in at-risk population s. This study examines the cost and cost-effectiveness of an SBI pilot program delivered in an inner-city hospital emergency department ( ED ) to a traditionally underserved population . METHOD A total of 1,036 subjects were screened for problem drinking during their visit to an ED . Eligible participants ( N = 294 ) were r and omly assigned to either a brief intervention group or a control group . As the result of attrition , a final sample of 194 ( 90 brief intervention ; 104 control ) participants remained at follow-up . The intervention consisted of a brief counseling session and a health information packet . The control group received only the packet .  Intervention cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program . Selected outcomes at the 3-month follow-up included the raw Alcohol Use Disorders Identification Test score , average weekly number of drinks and engaging in heavy drinking in the past month ( > 6 drinks on one occasion for men , > 4 for women ) . Outcome differences between the intervention and control groups were estimated with both bivariate and multivariate techniques . RESULTS The average economic cost of the brief intervention was dollars 632 per subject , of which screening ( dollars 497 ) was the largest component . In all cases , intervention subjects had better 3-month outcomes than control subjects , but the differences were not always statistically significant . Cost-effectiveness ratios were relatively small for all three outcomes , suggesting this type of intervention has the potential to be cost-effective under full implementation . CONCLUSIONS The preliminary results demonstrate the potential advantage of further research in this area with larger sample s and a longer follow-up period OBJECTIVE To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary -care setting s in Goa , India . METHODS Cost-utility and cost-effectiveness analyses based on generalized linear models were performed within a trial set in 24 public and private primary -care facilities . Subjects were r and omly assigned to an intervention or a control arm . Eligible subjects in the intervention arm were given psycho-education , case management , interpersonal psychotherapy and /or antidepressants by lay health workers . Subjects in the control arm were treated by physicians . The use of health-care re sources , the disability of each subject and degree of psychiatric morbidity , as measured by the Revised Clinical Interview Schedule , were determined at 2 , 6 and 12 months . FINDINGS Complete data , from all three follow-ups , were collected from 1243 ( 75.4 % ) and 938 ( 81.7 % ) of the subjects enrolled in the study facilities from the public and private sectors , respectively . Within the public facilities , subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm . Time costs were also significantly lower in the intervention arm than in the control arm , whereas health system costs in the two arms were similar . Within the private facilities , however , the effectiveness and costs recorded in the two arms were similar . CONCLUSION Within public primary -care facilities in Goa , the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving Introduction : Visits to setting s such as emergency departments ( EDs ) may present a “ teachable moment ” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors . Screening , Brief Intervention , and Referral to Treatment ( SBIRT ) is an ' opportunistic ' public health approach that targets low-risk users , in addition to those already dependent on alcohol and /or drugs . SBIRT programs provide patients with comprehensive screening and assessment s , and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use . Methods : This study used a single group pre-post test design to assess the effect of the California  SBIRT service program ( i.e. , CASBIRT ) on 6 substance-use outcomes ( past-month prevalence and number of days of binge drinking , illegal drug use , and marijuana use ) . Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers ( regardless of the reason for the patient 's visit ) using a short instrument , and then delivered a brief motivational intervention matched to the patient 's risk level . A total of 2,436 r and omly selected patients who screened positive for alcohol and /or drug use consented to be in a 6-month telephone follow-up interview . Because of the high loss to follow-up rate , we used an intention-to-treat approach for the data analysis . Results : Results of generalized linear mixed models showed modest reductions in all 6 drug- and alcohol-use outcomes . Men ( versus women ) , those at relatively higher risk status ( versus lower risk ) , and those with only one substance of misuse ( versus both alcohol and illicit drug misuse ) tended to show more positive change . Conclusion : These results suggest that SBIRT services provided in acute care setting s are associated with modest changes in self-reported recent alcohol and illicit drug use This article summarizes the proceedings of a symposium at the 2005 Research Society on Alcoholism , Santa Barbara , California . The purpose of the symposium was to address challenges that arise in translating evidence for efficacy of alcohol brief intervention ( BI ) into diverse clinical setting s and population s by review ing the literature and describing 4 research studies . Dr. Saitz review ed the limitations in evidence for efficacy of BIs and then described results of a r and omized clinical trial of brief motivational intervention for medical in patients drinking risky amounts . Dr. Svikis presented alternative methods for identifying pregnant women in prenatal care at risk for alcohol and drug problems ( including nicotine and caffeine ) and BIs to reduce or eliminate use . Dr. D'Onofrio discussed results of a r and omized trial of the brief negotiated interview in emergency department patients . Dr. Kraemer presented results of a decision analytic and computer-simulation model regarding the cost-effectiveness of alcohol screening  and intervention in primary care setting s. Finally , Dr. Perl discussed the salient issues and suggested future directions for work in the area of alcohol BI
Overall , the cohort Markov models remain the most popular approach , followed by decision trees , Individual based model and System dynamics model ( SD ) .
Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions
Background The overarching goal of health policies is to maximize health and societal benefits .
Economic evaluations can play a vital role in assessing whether or not such benefits occur .
This paper review s the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to ( i ) modelling paradigms themselves ; ( ii ) perspectives of costs and benefits and ( iii ) time frame .