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. Author manuscript; available in PMC: 2009 Oct 6.
Published in final edited form as: Alcohol Clin Exp Res. 2009 May 4;33(8):1440–1449. doi: 10.1111/j.1530-0277.2009.00974.x

Table 1.

Parameter List, Baseline Estimate, Range for Sensitivity Analysis, and Comment

Parameter Baseline Range Comments/citations
Probabilities
Demographics
 Initial age of cohort 50 18-80 Implies all individuals at the same initial age
 Prevalence of unhealthy drinking (%) Includes at-risk drinkers, alcohol abuse, and alcohol dependence; prevalence; values are a weighted average assuming 50% of cohort are male (Manwell et al., 1998)
  50-year-old cohort 22 10-40
  25-year-old cohort 28 15-45
  75-year-old cohort 6 1-20
 Prevalence of abuse (%) 11 7-15 Prevalence for the base case, 50-year-old patient
 Prevalence of at-risk drinking (%) 4 2-10
 Prevalence of dependence (%) 8 4-12
Test performance and prevalence
 Sensitivity of AUDIT-C questionnaire in women 81 50-99 Sensitivity and specificity to detect >7 drinks/wk or 4 or more drinks/day ± DSM IV disorder at a specificity of 86% (Bradley et al., 2003)
 Specificity of AUDIT-C questionnaire in women 86 50-100
 Sensitivity of AUDIT-C questionnaire in men 94 50-99 Sensitivity and specificity to detect >16 drinks/wk (Gordon et al., 2001)
 Specificity of AUDIT-C questionnaire in men 82 50-100
 Sensitivity of %CDT (men and women combined) 34 10-99 Sensitivity and specificity to detect individuals at-risk or more unhealthy drinking (reference standard AUDIT > 8) (Berner et al., 2006)
 Specificity of %CDT (men and women combined) 94 50-100
% delivery, treatment, and screening effects
 Delivery of brief intervention (BI) (%)
  At-risk 39 0-59 Probability of BI delivery by primary care provider after positive screen by questionnaire or %CDT; in the source publication (Burman et al., 2004), the 10-item AUDIT was used to categorize disease severity
  Abuse 59 39-71
  Dependence 71 59-100
  % individuals with dependence who follow up for alcohol treatment after brief intervention or usual care 40 10-90 Preliminary data from our own work for receipt of “alcohol assistance” (ASAP Study Clinical Trials Identifier NCT00183105) after brief intervention or usual care. (Note: In the model, 0% of alcohol dependents reduce their drinking after brief intervention alone; alcohol dependents must proceed to alcohol treatment before any benefit occurs)
  % at-risk drinkers or drinkers with alcohol abuse achieving low risk drinking after brief intervention 39 0-75 Percentage transitioning from at-risk or alcohol abuse to low risk drinking (e.g., within guidelines/suggested limits) after BI (Ockene et al., 1999)
  % dependent drinkers achieving low risk drinking after alcohol treatment 41 0-80 Percentage transitioning from dependence to recovery after alcohol treatment (Project MATCH authors, 1997)
 Screening effect parameters (%) Percentage transitioning from an unhealthy to healthy state after detection but without treatment; in the base case, the screening effects only applied to the No Screening strategy but was explored in sensitivity analyses.
  Abuse or at-risk to safe 28 0-50 From control arm of a randomized controlled trial for BI (Ockene et al., 1999)
  Dependence to recovery 14 0-50 No trial data for this parameter found; 1 year spontaneous probability of transition used (Schuckit et al., 2001)
 Percent follow up of a positive %CDT result 50 10-90 Composite probability that provider notifies patient and patient returns for full assessment
 Percent refusal of %CDT 0 0-100 Assumed this value is zero; refusal implies no change in cost-effectiveness
Utilities
 Nondrinker (age <65) 0.91 0.74-1.00 For all unhealthy states, we used standard gamble utilities measured in the community (Kraemer et al., 2005). For the utility of individuals with age > 65 in Nondrinker or Safe state, we used a generic, published utility for the well elderly (Gold et al., 1998)
 Safe drinker (age <65) 0.86 0.74-100
 Nondrinker or safe drinker (age 65 or more) 0.84 0.74-1.00
 At-risk drinker (all ages) 0.80 0.74-1.00
 Abuse drinker (all ages) 0.74 0.65-0.80
 Dependent drinker (all ages) 0.65 0.40-0.80
 Recovery (all ages) 0.81 0.74-0.86
Hazard ratios
 Nondrinker 1 1 Hazard ratio (of dying) for drinking state compared with nondrinker reference state (Dawson, 2000)
 Safe drinker 0.8 0.33-2.00
 At-risk 0.92 0.50-4.00
 Abuse drinker 1.07 0.50-1.00
 Dependent drinker 1.42 0.50-5.00
 Recovery 1.18 0.50-4.00
Costs
Initial costs (in $US)
 Questionnaire 3 0-50 CPT 99203 - 1 of 30 minutes assuming physician billed by time (Centers for Medicare & Medicaid, 2006b)
 %CDT 38 20-150 Medicare reimbursement CPT 82373 + venipuncture + 0.5 hour wages = $25 (Centers for Medicare & Medicaid, 2006a)+ $3 (Centers for Medicare & Medicaid, 2006a) + $9.50 (Bureau of Labor Statistics, 2005)
 Full assessment following positive questionnaire or case-finding 33 0-250 CPT 99203 - 10 of 30 minutes assuming physician billed based on time (Centers for Medicare & Medicaid, 2006b)
 Full assessment following positive %CDT 128 0-250 Follow-up visit (CPT 99213) + 3 hours wage + daily travel for patient (Centers for Medicare & Medicaid, 2006b)
 Brief intervention following positive questionnaire or case-finding 26 0-200 CPT 99203 - 7.5 of 30 minutes (Centers for Medicare & Medicaid, 2006b)
 Brief intervention following positive %CDT 0 0-200 No additional cost after new visit cost which permits 15-25 minutes of provider time
 Cost of alcohol dependence treatment 1,077 200-10,000 Includes provider costs as discussed by Cisler and colleagues (1998) + lost wages for 6 sessions, total 18 hours (Bureau of Labor Statistics, 2005) + 6 days of travel
 Cost of hourly wages lost for patient 19 5-30 National mean wage adjusted for inflation (Bureau of Labor Statistics, 2005)
 Cost of daily travel paid by patient 15 0-30 Estimated by authors
Future costs (in $US) Mean annual cost including out of pocket and third party disbursements for individuals without alcohol disorder (only listed for men) (Agency for Healthcare Research and Quality, 2004)
 Age 18-44 1,942 500-4,710
 Ages 45-64 4,710 1,942-9657
 Age 65 and over 9,657 4,710-20,00
Future cost multipliers
 Dependent drinker 2 1-3 Implies that future annual cost will be twice that of nondrinkers for each year lived with the disorder (Blose and Holder, 1991; Holder, 1998)
 Abuse 1.5 0.5-2 Implies that future annual cost will be 1.5 fold that of nondrinkers (estimated by authors)
 Recovery, at-risk, safe 1.0 1.0-2.0 Implies that future annual cost will be the same as that of nondrinkers (estimated by authors)