Costs of screening and brief intervention for illicit drug use in primary care settings.

Abstract

In this article, the authors estimate implementation costs for illicit drug screening and brief intervention (SBI) and identify a key source of variation in cost estimates noted in the alcohol SBI literature. This is the first study of the cost of SBI for drug use only. Using primary data collected from a clinical trial of illicit drug SBI (n = 528) and a hybrid costing approach, we estimated a per-service implementation cost for screening and two models of brief intervention. A taxonomy of activities was first compiled, and then resources and prices were attached to estimate the per-activity cost. Two components of the implementation cost, direct service delivery and service support costs, were estimated separately. Per-person cost estimates were $15.61 for screening, $38.94 for a brief negotiated interview, and $252.26 for an adaptation of motivational interviewing. (Amounts are in 2011 U.S. dollars.) Service support costs per patient are 5 to 7.5 times greater than direct service delivery costs per patient. Ongoing clinical supervision costs are the largest component of service support costs. Implementation cost estimates for illicit drug brief intervention vary greatly depending on the brief intervention method, and service support is the largest component of SBI costs. Screening and brief intervention cost estimates for drug use are similar to those published for alcohol SBI. Direct service delivery cost estimates are similar to costs at the low end of the distribution identified in the alcohol literature. The magnitude of service support costs may explain the larger cost estimates at the high end of the alcohol SBI cost distribution.