The Cost of Implementing SBI in an EAP Setting: Methodology and Preliminary Results

1. The Cost of Implementing SBI in an EAP Setting: Methodology and Preliminary Results Presented by Alexander J. Cowell RTI International Presented at INEBRIA, Gateshead, UK October 8, 2009 This research was conducted under NIAAA grant no. R01 AA013925

2. Acknowledgments Co-authors Jeremy Bray Jesse Hinde Michael Mills Funding National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health Grant R01 AA013925 (PI: Jeremy Bray) Participating agencies NEAS (formerly National Employee Assistance Services) Raleigh Employee Assistance Program, Inc. Other EAPs 2 6/6/2014

3. Background • Screening and Brief Intervention (SBI) thought to be a cost-effective strategy • Almost all cost studies focus on SBI being delivered • by a health care professional and • in an emergency room or primary care setting • Little known about the resources used when delivering SBI • in other settings and • by someone other than a health care professional

4. Literature • Variation in cost estimates across and within settings • E.g. of primary care • Zarkin et al. (2003) estimates are the lowest • Median screening cost across 5 sites was €0.34 ($0.50) per screen • €0.20 ($0.30) per pre-screening assessment) • Median BI cost was between €2.11 and €2.79 ($3.11 and $4.11) per BI • Mundt et al. (2005) estimates are the highest • Average screening cost was €118 ($174) per patient • Average BI cost was €58 ($86) per BI

5. Healthy Lifestyles Project • Examines SBI in EAP setting • Design has changed over time (next presentation) • AUDIT administered as part of intake assessment at affiliate office • CD-based, self-paced training program for delivery of SBI • We present the cost results

6. Methods: Overview • Perspective = Employer • Employer pays for the EAP services • Employer may pay for some employees to visit the EAP if visit is during work hours • Cost = p * q • Price • Cost of one minute of one screen or BI • Quantity • Time taken for one screen or BI

7. Methods: Measuring P • Records from sites, study, literature, and online sources • Salary and fringe • National medians by job type from US Bureau of Labor Statistics • Space • Area-specific real estate estimates. Some interpolation required • Overhead • Literature: direct/indirect proportion from study of methadone clinics

8. Methods: Measuring Q • Screening • Used synthetic sample • Assumed no distinction b/w intervention and control • Brief Intervention • Brief counselor questionnaire that elicited • Total time in session • Time spent on each of six topics – alcohol and five others (e.g. tobacco) • Attributable cost was that portion of the session reported to be dedicated to alcohol

9. Methods: Sample and Analysis • 94 counselor questionnaires at 28 EAP providers across U.S. • Ongoing data collection effort • Estimated • Start-up costs (training) • Cost per screen • Cost per BI • Focus here on implementation costs (not training)

10. Screen: Cost (2009 Euros)

11. BI: Time (minutes)

12. BI: Cost (2009 Euros)

13. SBI: Total Employer Cost (2009 Euros)

14. Conclusion • Screening • Low cost, as expected • On par with lowest costs in literature • Brief Intervention • Second-lowest cost estimates in the literature • A priori, expected intervention session to have more time on alcohol than control • In fact, about the same time spent on alcohol across study arms • Therefore about the same cost • If any effectiveness found, intervention likely to be found cost-effective