1. Presented by Alexander J. Cowell
Brief Intervention Costs in Two Populations in the United States: College Students and US Air Force Personnel
Presented by
Alexander J. Cowell
Presented at
INEBRIA, Gateshead, UK
October 9, 2009

2. Acknowledgments PI for both is Dr. Janice Brown Air Force College
Many colleagues and collaborators at RTI and US Air Force
Yuta Masuda and Brendan Wedehase
Funding from Department of Defense W81XWH
College
Many colleagues and collaborators at RTI and study site
National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health R01 AA
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3. Background Intervene with risky drinkers
Both populations have problem drinkers
Young adults aged 18 to 25 are the age group with the highest rates of heavy alcohol use
Air Force population: In 2005, 10.3% of Air Force personnel in the sample reported heavy drinking over the past 30 days (Bray and Hourani, 2007)
College population: In 2001, 44% of college students in the sample reported binge drinking (Wechsler et al., 2002)
Little known about cost of MI for these groups
AF drinking: Bray, RM, and LL Hourani "Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys, " Addiction 102, no. 7: CINAHL Plus with Full Text, EBSCOhost (accessed October 1, 2009).
The drinking level and classification was created with an algorithm consisting of eight items that inquired about the frequency of drinking and amount of each type of beverage (beer, wine or hard liquor) and classified respondents into drinking categories ranging from abstainer to heavy drinker.
College drinking: WECHSLER, H., LEE, J.E., KUO, M., SEIBRING, M., NELSON, T.F., AND LEE, H. Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public Health College Alcohol Study surveys: J. Amer. Coll. Hlth 50: , 2002b.
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4. Methods: Treatment Groups
Air Force
4 bases
3 study arms
Treatment as Usual (TAU)
A full day of alcohol education and information sessions
6-10 hour session
Group MI (GMI)
MI in a group of 3 – 5
2-2.5 hour session
Individual MI (IMI)
Usual MI
hour session
College
1 university campus
4 study arms
Assessment Only
No treatment
Feedback
Feedback report based on participant drinking habits
MI Only
MI with Feedback
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5. Methods: Main Study Eligibility Outcomes Preliminary screening
Air Force: referral
College: at recruitment
AUDIT or other screening
Exclude dependents
Include risky drinkers
Outcomes
Survey
Number of drinking days in past 30 days
Number of heavy episodic drinking days in past 30 days
Average drinks per drinking day
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6. Methods: Economic Evaluation
Cost Perspective
Air Force and client
College
Cost = P * Q
Price
From various records
Quantity
Detailed records of activities
Log kept by interventionists
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7. RESULTS
Air Force
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8. Startup Costs (€2009)
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9. Time per Intervention (minutes)
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10. Cost per Client of Providing the Intervention (€2009)
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11. Cost per Client of Client’s Time and Expenses (€2009)
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12. Total Cost (€2009)
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13. RESULTS
College
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14. Trainee Time
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15. Startup Costs (€2009)
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16. Time per Intervention (minutes)
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17. Cost per Intervention (€2009)
P-value for FB vs MI is
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18. Cost per Intervention Sensitivity Analysis (€2009)
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19. Comparing the Two Studies
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20. Comparison of Start-up Costs
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21. Comparison of MI Cost Average length of MI Air Force MI: 80 minutes
College MI: 33 minutes
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22. Discussion and Conclusion
Similar start-up costs
Different implementation costs
Next Step: Cost-Effectiveness
Evidence for both studies of improvement in outcome
Air Force
Outcome study has low n and high attrition
If value of client time is included, TAU is not likely to be cost-effective
College
Outcome study has high n and low attrition
Sensitivity of conclusions to assumptions made in “feedback only” arm may well affect cost-effectiveness conclusions
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