Potential Cost Savings Associated with Providing Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorder in Emergency Departments: Rapid Review

RESEARCH REPORT Potential Cost Savings Associated with Providing Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorder in Emergency Departments A Rapid Review Lisa Clemans-Cope Sarah Benatar Marni Epstein Nikhil Holla June 2018 HEALTH POLICY CENTER ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is a leading research organization dedicated to developing evidence-based insights that improve people’s lives and strengthen communities. For 50 years, Urban has been the trusted source for rigorous analysis of complex social and economic issues; strategic advice to policymakers, philanthropists, and practitioners; and new, promising ideas that expand opportunities for all. Our work inspires effective decisions that advance fairness and enhance the well-being of people and places. Copyright © June 2018. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image by Tim Meko. Contents Acknowledgments iv Executive Summary v Introduction 1 Purpose of This Review 2 Methods 4 Eligibility Criteria 4 Search Strategy 5 Study Selection 5 Study Data Extraction and Quality Assessment 6 Data Extraction 6 Data Synthesis 7 Results 8 Comparison of the Estimates of the Intervention Costs 8 Comparison of the Estimates of Savings 10 Discussion 14 Generalizability and Limitations of This Review 15 Conclusions 16 References 17 About the Authors 20 Statement of Independence 21 IV ACKNOWLEDGMENTS Acknowledgments This report was funded by the California Health Care Foundation. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of Urban experts. Further information on the Urban Institute’s funding principles is available at urban.org/fundingprinciples. The authors are grateful to Genevieve Kenney and Stephen Zuckerman for their helpful comments and suggestions and to Fiona Blackshaw and Vicky Gan for their copyediting. EXECUTIVE SUMMARY V Executive Summary This report provides a rapid review of recently published evidence on the potential cost savings associated with providing screening, brief intervention, and referral to treatment (SBIRT) for people with substance use disorders (SUDs) in emergency departments (EDs). The review focuses on studies related to alcohol and drug use disorders with the aim of characterizing economic evaluations of interventions from existing literature that can inform cost savings for similar initiatives. A growing number of localities and states are considering implementing SUD screening, brief intervention, and referral in the ED setting. These programs could be the foundation for future service expansions including the initiation of SUD treatment in the ED, which could substantially increase access to evidence-based SUD treatment. Over approximately two weeks, the research team synthesized available peer-reviewed evidence using a comprehensive search strategy of literature published after 2010. Consistent with established practices of rapid review, the search strategy was not designed to be an exhaustive search of the published and gray literature. Studies were excluded based on an initial title/abstract eligibility assessment and then a full text eligibility assessment. Study quality was evaluated using established quality assessment criteria, and less rigorous or low-quality studies were excluded. Eight p eer-reviewed studies were deemed eligible for inclusion. A consistent set of key elements was extracted from all eligible studies. Taken as a whole, the eight studies suggested that screening, brief intervention, and referral to treatment for SUD in the ED is cost-effective. Four of the eight studies examined the per patient cost of intervention in the ED setting, including the costs of direct service delivery, service support, and space. Intervention costs were estimated to be between approximately $4 and $54 for screening (including any prescreening), though some estimates exceeded $76; between $4 and $94 for brief intervention and $22 for brief treatment; and between $8 and $27 for referral to treatment (Barbosa et al. 2016; Bray et al. 2012, 2014; Horn et al. 2017). Altogether, the aggregated per patient cost of each component of the intervention was between $24 and $173, with the middle range of total per patient interventions costs estimated at $39, $52, and $138; costlier interventions were sometimes more extensive (e.g., including booster sessions). Five of the eight studies that met eligibility criteria examined potential per patient savings related to SUD screening, brief intervention, and referral in the ED setting. Three of those studies found substantial savings (Pringle et al. 2018; Estee et al. 2010; Barbosa et al. 2015),