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Biomedical subjects

Gary A Zarkin

Publications and source records attributed to Gary A Zarkin.

14 recordsLinked to original sources
PubMed2007

The effect of screening and brief intervention for risky drinking on health care utilization in managed care organizations.

OBJECTIVE: We sought to estimate the effect of screening and brief intervention (SBI) for risky alcohol use on the health care utilization of risky drinkers in 4 managed care organizations. RESEARCH DESIGN: A quasi-experimental group design was implemented in which 12 participating primary care clinics randomly were assigned to 1 of 3 study conditions. In one condition, physicians, physician assistants, and nurse practitioners delivered the brief intervention. In another condition, midlevel professionals (usually nurses) performed the brief intervention. In the third condition, SBI was not performed. Using administrative claims data, we estimated the effect of SBI on individual-level annual days of total and inpatient health care utilization; annual outpatient visits; annual emergency room visits; and annual visits related to alcohol, drug, or mental health conditions. Negative binomial regression models were used to control for other factors that may affect health care utilization. RESULTS: Across all categories of care, the pre- to postintervention change in average health care utilization among risky drinkers in the intervention clinics was not significantly different from that of risky drinkers in the comparison clinics. CONCLUSIONS: Our findings suggest that there is no effect of SBI on the health care utilization of risky drinkers in the year following the intervention. Although SBI does not appear to reduce health care utilization, previous studies find that it significantly reduces the alcohol consumption of risky drinkers. Because these reductions presumably improve patients' overall health and well-being, managed care organizations may still find it beneficial to implement SBI on a broad scale.

Adult↗
PubMed2006

Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations.

AIMS: Evaluate effectiveness and costs of brief interventions for patients screening positive for at-risk drinking in managed health care organizations (MCOs). METHODS: A pre-post, quasi-experimental, multi-site evaluation conducted at 15 clinic sites within five MCO settings. At-risk drinkers (N = 1329) received either: (i) brief intervention delivered by licensed practitioners; or (ii) brief intervention delivered by mid-level professional specialists (nurses); or (iii) usual care (comparison condition). Clinics were randomly assigned to three study conditions. Data were collected on the cost of screening and brief intervention. Follow-up interviews were conducted at 3 and 12 months. RESULTS: Participants in all three study conditions were drinking significantly less at 3-month follow-up, but the decline was significantly greater in the two intervention groups than in the control group. There were no significant differences between the two intervention conditions. Of the patients in the intervention conditions 60% reduced their alcohol consumption by > or =1 drink per week, compared with 53% of those in the control condition. No differences were found on a measure of the quality of life. Differential reductions in weekly alcohol consumption between intervention and control groups were significant at 12-month follow-up. Average incremental costs of the interventions were 4.16 US dollar per patient using licensed practitioners and 2.82 US dollar using mid-level specialists. CONCLUSION: Alcohol screening and brief intervention when implemented in managed care organizations produces modest, statistically significant reductions in at-risk drinking. Interventions delivered to a common protocol by mid-level specialists are as effective as those delivered by licensed practitioners at about two-thirds the cost.

Alcohol Drinking↗
PubMed2006

The costs of pursuing accreditation for methadone treatment sites: results from a national study.

The use of accreditation has been widespread among medical care providers, but accreditation is relatively new to the drug abuse treatment field. This study presents estimates of the costs of pursuing accreditation for methadone treatment sites. Data are from 102 methadone treatment sites that underwent accreditation as part of the Center for Substance Abuse Treatment's evaluation of the Opioid Treatment Program Accreditation Project. The analysis represents the most comprehensive analysis of the costs of pursuing accreditation by a health care provider. Importantly, it is the first analysis of the costs of pursuing accreditation by drug treatment providers. Policy makers and drug treatment providers can use this analysis to plan the labor requirements and costs of future accreditation initiatives.

Accreditation↗
PubMed2006

Economic evaluation of alcoholism treatment.

Rising health care costs in recent years have increased pressures on providers, insurers, and policymakers to monitor the costs, cost-effectiveness, and cost-benefit of all health care services, including alcohol-related services. Without solid information regarding the economic implications of alcohol-related services, health insurance companies, managed care organizations, and policymakers may be reluctant to fund these services. As reviewed in this article, economic analyses-such as cost, cost-effectiveness, and cost-benefit analyses, including cost-offset studies--have been applied to alcoholism treatment outcomes research to provide such information. Methodological issues discussed here that concern these approaches will shape the future direction of economic analyses in the alcohol field.

Alcoholism↗
PubMed2005

Benefits and costs of methadone treatment: results from a lifetime simulation model.

Several studies have examined the benefits and costs of drug treatment; however, they have typically focused on the benefits and costs of a single treatment episode. Although beneficial for certain analyses, the results are limited because they implicitly treat drug abuse as an acute problem that can be treated in one episode. We developed a Monte Carlo simulation model that incorporates the chronic nature of drug abuse. Our model represents the progression of individuals from the general population aged 18-60 with respect to their heroin use, treatment for heroin use, criminal behavior, employment, and health care use. We also present three model scenarios representing an increase in the probability of going to treatment, an increase in the treatment length of stay, and a scenario in which drug treatment is not available to evaluate how changes in treatment parameters affect model results. We find that the benefit-cost ratio of treatment from our lifetime model (37.72) exceeds the benefit-cost ratio from a static model (4.86). The model provides a rich characterization of the dynamics of heroin use and captures the notion of heroin use as a chronic recurring condition. Similar models can be developed for other chronic diseases, such as diabetes, mental illness, or cardiovascular disease.

Adult↗
PubMed2005

Cost methodology of COMBINE.

OBJECTIVE: This article describes the methodology used in estimating the mean cost per patient of the interventions delivered in COMBINE, a randomized controlled trial (RCT) comparing pharmacotherapies and behavioral interventions for outpatient treatment of alcohol dependence. METHOD: Our methodology identifies a broad list of nonresearch activities necessary to implement the COMBINE interventions in standard clinical practice. For each activity, we include the time costs of clinical assessments and interventions by staff, the cost of space, laboratory charges and the cost of medical supplies. We also estimate the patients' time used for each of these activities. RESULTS: We present the estimated cost per activity for 15 intake assessments plus the Medical Management (MM) and Combined Behavioral Intervention (CBI) sessions for 9 of the 11 COMBINE sites. Labor costs represent the bulk of the total cost for all activities. The Form 90 AIR/ED is the most expensive intake activity both in terms of labor and space costs. The CBI session is more expensive than the MM session. CONCLUSIONS: Our methodology estimates the cost to treatment providers and to patients of implementing the COMBINE intervention in standard practice. Compared with previous methods, the prospective design of our methodology allows for higher quality data, and the detailed activity costing helps identify key cost drivers. Future analyses will present actual COMBINE intervention cost estimates based on trial data. Although this cost study is specific to the COMBINE interventions, the concepts, instruments and methods used here can be applied to any RCT.

Alcoholism↗
PubMed2004

Alcohol drinking patterns and health care utilization in a managed care organization.

OBJECTIVE: To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. STUDY DESIGN: Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity-frequency and AUDIT-based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. PRINCIPAL FINDINGS: For both the quantity-frequency and AUDIT-based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. CONCLUSIONS: Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern.

Adult↗
PubMed2004

Pharmacogenomics and the evolution of healthcare : is it time for cost-effectiveness analysis at the individual level?

The efficacy and toxicity of any given drug can vary substantially from one individual to another. The heterogeneity in individual genetics contributes, in part, to this variability. Pharmacogenomics uses each patient's individual genetic information to identify the drug with the best efficacy-safety profile for that patient. However, heterogeneity is also present in individuals' preferences for alternate efficacy-safety profiles. We argue that as healthcare evolves towards individualised drug therapy, preference elicitation and cost-effectiveness analysis should also be performed at the individual level to maximise societal welfare.

Cost-Benefit Analysis↗
PubMed2003

The costs of screening and brief intervention for risky alcohol use.

OBJECTIVE: The purpose of this study was to estimate provider-incurred costs of alcohol screening and brief intervention (SBI) for risky drinking as implemented in four managed care organizations (MCOs) participating in the Cutting Back project implemented by the University of Connecticut Health Center. METHOD: Each MCO provided two comparable primary care clinics in which two different SBI models were implemented: the "Practitioner" (P) model and the "Specialist" (S) model. Risky drinkers were identified based on responses to a health appraisal form. They were administered the AUDIT to determine an appropriate intervention. Using data collected from these sites, we separately estimated start-up and ongoing implementation costs of the intervention. RESULTS: SBI start-up costs per MCO ranged from approximately dollars 86,000 to dollars 115,000 across the four study MCOs. Across all four study MCOs, the estimated median ongoing implementation cost of administering the health appraisal was dollars 0.25 per patient appraised, and the estimated median cost of screenings was dollars 0.42 per patient screened. The estimated median cost of performing the brief intervention across the study MCOs was dollars 2.59 per patient receiving the intervention in the S clinics and dollars 3.43 per patient receiving the intervention in the P clinics. Labor costs dominated start-up and ongoing implementation. Technical assistance costs accounted for a significant proportion of start-up costs. Implementation in the S model is less costly than in the P model, largely because of the S model's use of less expensive nonphysician labor. CONCLUSIONS: Our analysis suggests that the cost of SBI is modest, and MCOs may want to consider adopting SBI as an alcohol use prevention tool. Although our results suggest that the S model is less costly than the P model, clinic-level implementation factors may affect the relative costs of the S versus P models.

Alcoholism↗
PubMed2002

The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment.

Length of stay in treatment has been found to be a significant predictor of positive post-treatment outcomes, such as decreases in unemployment and crime. However, length of stay may be an incomplete predictor of successful treatment. Surprisingly, few studies have examined whether completing treatment in addition to length of stay is an important factor in explaining positive treatment outcomes. The objective of our study is to examine the effect that treatment completion and length of stay have on post-treatment employment and crime for patients in outpatient drug-free treatment, the largest treatment modality in the United States. We use conditional logit and multiple regression models with program-level indicator variables (fixed effects) to estimate the effect of treatment completion and length of stay on employment and crime controlling for drug use severity, previous treatment history, and other patient demographics. Data are from the National Treatment Improvement Evaluation Study and include 986 adults enrolled in outpatient drug-free programs across the United States. We find that treatment completion and length of stay are significantly related to post-treatment employment. Holding length of stay constant, the occurrence of employment at follow-up among patients who complete their planned treatment is almost 2 times that of patients who do not complete treatment. However, treatment completion did not have a statistically significant effect on the probability of post-treatment crime. Although our results are mixed, these findings suggest that greater attention should be placed on evaluating the importance of both length of stay and treatment completion in treatment outcome studies.

Adult↗
PubMed2002

Application of cost-effectiveness analysis to multiple products: a practical guide.

The appropriate interpretation of cost-effectiveness results and its use in treatment decision making have been debated vigorously. In this report we have summarized the decision rules described in the health economics literature to determine which intervention should be chosen from among multiple treatment options for a given disease, using a graphic framework. The implications of different means of expressing budget constraints on treatment choice are examined.

Algorithms↗
PubMed2002

Decision latitude and workload demand: implications for full and partial absenteeism.

This research examined the relative importance of two components of job stress--decision latitude and workload demand--on employee absenteeism. The analysis was based on confidential self-reported data from employees at two worksites, which were collected in three independent cross-sections beginning in 1995. The negative binomial technique was used to estimate the effects of decision latitude and workload demand on employee attendance, while controlling for employee demographics and other workplace characteristics. Estimation results show that high decision latitude was negatively and significantly related to number of full days absent from work (full absenteeism) and number of days arriving late to work or leaving work early (partial absenteeism). Conversely, the coefficient estimates for low decision latitude were positive in every model and significantly related to partial absenteeism. Low workload demand was negatively and significantly related to partial absenteeism, but not full days absent. The interaction effects of decision latitude and workload demand on absenteeism were not statistically significant. Several recent studies have estimated a significant relationship between decision latitude, workload demand, and medical problems such as cardiovascular disease. The current findings suggest that decision latitude and workload demand are also related to workplace attendance. Employers and occupational hygienists should consider decision latitude and workload demand as a means to improve workplace productivity and employee health.

Absenteeism↗
PubMedDate not supplied

Conditions for the near equivalence of cost-effectiveness and cost-benefit analyses.

The equivalence of cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) has been vigorously debated in the health economic literature. In this paper we review and refine the conditions for the equivalence of CEA and CBA. The previously stated conditions require that 1) each individual's willingness to pay (WTP) per quality-adjusted life year (QALY) is constant and does not vary with the magnitude of QALY gains, and 2) the WTP per QALY is identical for every individual in society. Based on mathematical programming formulations of CEA and CBA, we note that condition 2 can be replaced with two other conditions, which together are less restrictive than the requirement that every individual have the same WTP per QALY. Even with this less restrictive set of conditions, CEA and CBA are unlikely to be equivalent under real world conditions. When CEA and CBA do lead to different resource allocation decisions, the most appropriate framework for health economic analysis depends on the perspective regarding distribution issues. We also examine the equivalence of two different definitions of CEA provided in the literature and discuss the problems that could arise when there are multiple optima.

Attitude to Health↗