The Relationship Between End‐of‐Treatment Alcohol Use and Subsequent Healthcare Costs: Do Heavy Drinking Days Predict Higher Healthcare Costs?. (May 2016)

• Record Type: Journal Article
• Authors: Aldridge, Arnie P.; Zarkin, Gary A.; Dowd, William N.; Bray, Jeremy W.
• Is Part Of: Alcoholism. Volume 40:Number 5(2016)
• Page Start: 1122
• Page End: 1128
• Publication Date: 2016-05
• Subjects: Costs -- Treatment -- Low Risk -- Heavy Drinking; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13054
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: A challenge for evaluating alcohol treatment efficacy is determining what constitutes a "good" outcome or meaningful improvement. Abstinence at the end of treatment is an unambiguously good outcome; however, a focus on abstinence ignores the potential benefits of patients reducing their drinking to less problematic levels. Patients may be drinking at low‐risk levels at the end of treatment but may be high‐functioning and impose few social costs. In this study, we estimate the relationship between drinking at the end of COMBINE treatment and subsequent healthcare costs with an emphasis on heavy and nonheavy drinking levels. Methods: Indicators of heavy drinking days ( HDDs ; 5+ drinks for men, 4+ for women) and nonheavy drinking days ( non‐HDDs ) during the last 30 days of COMBINE treatment were constructed for 748 patients enrolled in the COMBINE Economic Study. Generalized linear models were used to model total costs following COMBINE treatment as a function of drinking indicators. Different model specifications analyzed alternative counts of HDDs (e.g., 1 HDD and 2 to 30 HDDs ), and groups having Both non‐HDDs and HDDs . Results: Patients with HDDs had 66.4% ( p < 0.01) higher healthcare costs than those who were abstinent. Having more than 2 HDDs was associated with the highest costs (75.9%, p < 0.01). Patients with non‐HDDs had costs that were not significantly different than abstainers, even if they also had HDDs. However, those with HDDs only had costs 91.7% higher than abstainers ( p < 0.01). Conclusions: Having HDDs at the end of treatment is associated with higher costs. Patients who had Only HDDs at the end of treatment had worse subsequent outcomes than those who had Both non‐HDDs and HDDs . These findings offer new context for evaluating treatment outcomes and provide new information on the association of drinking with consequences. Abstract : Drinking outcomes in the COMBINE RCT were evaluated based on subsequent healthcare costs. Patients were categorized by whether they were abstinent in the last 30 days of the trial, had only nonheavy drinking days, had only heavy drinking days, or had both nonheavy and heavy drinking days. Patients with any nonheavy drinking days did not have higher costs than those who were abstinent, even if they also had heavy drinking days. Patients with only heavy drinking days had the highest costs.