RTI International is a trade name of Research Triangle Institute 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

11/20/ 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 AA (PI: Jeremy Bray) Participating agencies –NEAS (formerly National Employee Assistance Services) –Raleigh Employee Assistance Program, Inc. –Other EAPs

11/20/ 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

11/20/ 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

11/20/ 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

11/20/ 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

11/20/ 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

11/20/ 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

11/20/ 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)

11/20/ Screen: Cost (2009 Euros) EAP Labor Cost€0.05 Employee Labor Cost€0.32 Indirect Space Cost €0.07 Total Cost of One Screen to Employer€0.44

11/20/ BI: Time (minutes) Intervention N = 57 Control N = 37 Reported Session Length (s.d )(s.d ) Reported Time Spent on Alcohol30%29% Reported Time Spent on Illicit Drug Use3% Reported Time Spent on Stress Management 14%18% Reported Time Spent on Diet5%3% Reported Time Spent on Smoking2% Unattributed Time During Session39%41%

11/20/ BI: Cost (2009 Euros) Intervention Control EAP Counselor Labor Cost€10.12€9.30 Space€0.87€0.79 Fixed Clinical Supervision Cost€2.67 Total EAP Cost€13.66€12.76

11/20/ SBI: Total Employer Cost (2009 Euros) Intervention Control Total EAP Cost €13.66€12.76 Employee Labor Cost €4.51 €4.14 Total Brief Intervention Cost to Employer €18.17€16.90 Total Screening Cost to Employer €0.44 Total SBI Cost €18.60€17.33

11/20/ 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