The short-term impact on economic outcomes of SBIRT interventions implemented in reproductive health care settings

Abstract

Objective: To estimate the impact of screening, brief intervention, and referral to treatment (SBIRT) administered in reproductive health care settings on a variety of economic outcomes, including general health care utilization, criminal activity, and motor vehicle crashes. Whether and by how much SBIRT affects economic outcomes are important unanswered questions related to the economic impact of this technique. Methods: We collected data as part of a randomized clinical trial that examined whether SBIRT delivered electronically (e-SBIRT) or by a clinician (SBIRT) is superior to enhanced usual care (EUC) for substance misuse. Participants were a convenience sample of 439 women from two reproductive health care centers who used cigarettes, risky amounts of alcohol, illicit drugs, or misused prescription medication. For each participant, we measured economic outcomes by self-report 6 months pre- and post-intervention. We used difference-in-differences regression models to estimate the impact of e-SBIRT and SBIRT, compared to EUC, on changes in each of the economic outcomes from pre- to post-intervention. Results: None of the difference-in-differences estimates weas statistically significant after adjusting for multiple comparisons. Conclusion: In a population of women receiving routine care in reproductive health care settings, we did not find a significant effect of either e-SBIRT or SBIRT, compared to EUC, on general health care utilization, criminal activity, or motor vehicle outcomes. However, individual trials are typically underpowered to detect effects that are small but important from a public health perspective. These results may be crucial for future systematic reviews and meta-analyses to determine the economic impact of SBIRT programs from a variety of perspectives.