The Costs and Benefits of Screening With Carbohydrate-Deficient Transferrin in Primary Care

The costs and benefits of using biomarkers to screen primary care patients for unhealthy alcohol use is unknown. Using a decision-analysis model based on published data, researchers estimated the costs and benefits of alcohol screening with carbohydrate-deficient transferrin (CDT) in primary care settings. The model, which focused on patients with diabetes and/or hypertension, assumed that 70 of 1000 simulated patients would drink heavily* and that all who screened positive would receive brief intervention.

• Self-report of alcohol use (without use of validated screening questionnaires) would identify 28 of 70 (40%) heavy drinkers. CDT plus self-report would identify 53 of 70 (76%).
• CDT plus self-report, compared with self-report alone, would save $212.30 in medical, legal, and motor-vehicle accident costs.
• CDT plus self-report remained cost-saving in 83% of the multivariate simulations.

Comments:

This well-done analysis provides some preliminary support to using CDT for alcohol screening in primary care. However, before widespread implementation is considered, future cost-benefit and cost-effectiveness analyses should directly compare CDT-based screening with screening conducted with standard instruments, such as the CAGE or AUDIT.**

Kevin L. Kraemer, MD, MSc

Reference:

Dillie KS, Mundt M, French MT, et al. Cost-benefit analysis of a new alcohol biomarker, Carbohydrate Deficient Transferrin, in a chronic illness primary care sample. Alcohol Clin Exp Res. 2005;29(11):2008–2014.