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Cost-effectiveness of Electronic- and Clinician-Delivered Screening, Brief Intervention, and Referral to Treatment for Women in Reproductive Health Centers.

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, Connecticut, 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 6-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the 6-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 healthcare 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 the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18.


CONCLUSIONS
e-SBIRT could be a cost-effective approach, from both healthcare provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.