Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes

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Abstract

© 2016 Elsevier Ireland LtdBackground Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. Methods We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12–19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. Results Those who received the intervention had lower costs ($22 versus $227: z = 3.16, p = 0.002) and rates (0.03 versus 0.25: z = 2.57, p = 0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p = 0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p = 0.924), overall ED presentations ($4266 versus $4150, p = 0.916), out-patient mental health services ($4494 versus $7717, p = 0.282), or opiate pharmacotherapies ($1013 versus $2054, p = 0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z = 2.64, p = 0.008). Conclusions An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.
Original languageEnglish
Pages (from-to)168-174
JournalDrug and Alcohol Dependence
Volume165
DOIs
Publication statusPublished - 2016

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Hospital Emergency Service
Economics
Health
Costs and Cost Analysis
Alcohols
Opiate Alkaloids
Costs
Pharmaceutical Preparations
Drug therapy
Health Care Costs
Mental Health
Outpatients
Drug Therapy
Cost of Illness
Information Storage and Retrieval
Hospital Departments
Mental Health Services
Hospital Mortality
Ireland
Linear Models

Cite this

@article{a3a4988d5a5c46c5bc0cbbaf33de48f0,
title = "Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes",
abstract = "{\circledC} 2016 Elsevier Ireland LtdBackground Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. Methods We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12–19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. Results Those who received the intervention had lower costs ($22 versus $227: z = 3.16, p = 0.002) and rates (0.03 versus 0.25: z = 2.57, p = 0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p = 0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p = 0.924), overall ED presentations ($4266 versus $4150, p = 0.916), out-patient mental health services ($4494 versus $7717, p = 0.282), or opiate pharmacotherapies ($1013 versus $2054, p = 0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z = 2.64, p = 0.008). Conclusions An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.",
author = "R.J. Tait and Lucie Teoh and Erin Kelty and Elizabeth Geelhoed and David Mountain and Gary Hulse",
year = "2016",
doi = "10.1016/j.drugalcdep.2016.06.005",
language = "English",
volume = "165",
pages = "168--174",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier",

}

TY - JOUR

T1 - Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes

AU - Tait, R.J.

AU - Teoh, Lucie

AU - Kelty, Erin

AU - Geelhoed, Elizabeth

AU - Mountain, David

AU - Hulse, Gary

PY - 2016

Y1 - 2016

N2 - © 2016 Elsevier Ireland LtdBackground Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. Methods We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12–19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. Results Those who received the intervention had lower costs ($22 versus $227: z = 3.16, p = 0.002) and rates (0.03 versus 0.25: z = 2.57, p = 0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p = 0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p = 0.924), overall ED presentations ($4266 versus $4150, p = 0.916), out-patient mental health services ($4494 versus $7717, p = 0.282), or opiate pharmacotherapies ($1013 versus $2054, p = 0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z = 2.64, p = 0.008). Conclusions An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.

AB - © 2016 Elsevier Ireland LtdBackground Alcohol and other drug (AOD) use are significant cause of disease burden and costs among adolescents. Methods We conducted a randomized trial in hospital emergency departments (ED) following an AOD-related presentation, comparing usual care with brief advice and referral to link adolescents aged 12–19 years with external AOD services. Subsequently, we used health data linkage to assemble data on mortality, hospital admissions, ED attendances, out-patient mental health and use of opiate pharmacotherapies in the next 10 years. From these, treatment costs and rates of events were estimated and compared using generalized linear models. Results Those who received the intervention had lower costs ($22 versus $227: z = 3.16, p = 0.002) and rates (0.03 versus 0.25: z = 2.57, p = 0.010) of ED mental health AOD presentations. However, the intervention did not significantly reduce overall mean health costs per patient (intervention $58746 versus control $64833, p = 0.800). Similarly, there was no significant difference in the costs associated with hospitalizations ($48920 versus $50911 p = 0.924), overall ED presentations ($4266 versus $4150, p = 0.916), out-patient mental health services ($4494 versus $7717, p = 0.282), or opiate pharmacotherapies ($1013 versus $2054, p = 0.209). Injecting drug use was a significant baseline predictor of subsequent costs in the cohort (z = 2.64, p = 0.008). Conclusions An ED delivered intervention may reduce direct ED costs and subsequent ED AOD attendances. There was also some indication that overall costs may be impacted, with economically large but non-significant differences between the groups. The high costs and morbidity incurred by some of this cohort illustrate the importance of targeting high-risk adolescents.

U2 - 10.1016/j.drugalcdep.2016.06.005

DO - 10.1016/j.drugalcdep.2016.06.005

M3 - Article

VL - 165

SP - 168

EP - 174

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -