The effect of an alcohol ignition interlock programme (AIIP) upon the costs of health care utilization among DWI offenders

1
The effect of an alcohol ignition interlock
programme (AIIP) upon the costs of health care
utilization among DWI offenders

• Bo Bjerre
• Traffic Medicine Advisory Board,
• Swedish Road Administration, Borlänge, Sweden
• Johan Kostela
• Dalarna Research Institute (Dalarnas
  Forskningsråd), Falun, Sweden
• Jan Selén
• Statistics, Stockholm,Sweden

2
The design of the interlock program (AIIP)

• Interlock device checked bimonthly
• Every third month compulsory medical examination
  biological markers, toxicological urine analysis,
  AUDIT
• From the 5th examination (12 months in the
  program) biological markers must verify sober
  living
• Expensive (about 5 000 for 2 years) The full
  cost borne by the offender

3
The design..

• If passing the 2-year program
• regarded as rehabilitated from a traffic safety
  point of view
• and thus reissued full driving licence

4
Previous results of the AIIP
5
Previous results of the AIIP
6
Previous results of the AIIP
7
Study design

• A quasi-experimental intent-to-treat design
• Intervention group with 1 156 participants in the
  AIIP and including those 48 being dismissed
• Control group with 815 individuals with revoked
  licences but without opportunity to participate
  in an AIIP
• Only individuals between the ages of 24 and 60
  were included

8
Cost analysis

• Three different costs were calculated
• The cost for sickness benefit and disability
  pension and the cost for hospital care of
  in-patients
• Each reported cost has been recalculated to the
  price index of the year 2003.

9
Average number of care days in hospital per
person and year. Care under all diagnosis in the
AIIP and the control group. Each category is one
year of data except the adm. period which is 3
months
10
The average number of days of sick leave per
person and year. Participants in AIIP and
controls. Each category is one year of data
except the adm. period which is 3 months.
11
The average cost caused by sick leave and
disability pension per person and year.
Participants in AIIP and controls.
12
The combined average costs caused by sick leave
and disability pension per person and year.
Participants in AIIP and controls.
13
The average cost caused by sick leave and
disability pension per person and year. The
difference between the AIIP and control group,
controls as reference
14
The average costs caused by sick leave and
disability pension per person and year. A
comparison between completed and dismissed in the
AIIP.
15
The total costs (prior to regression analysis)
caused by sick leave, disability pension and
hospital in-patient care. Average costs in SEK
per person and year.
16
Total health care costs. Expected cost
differences (after regression analysis) between
AIIP participants and controls. Average costs in
SEK per person/year.
17
ConclusionsDifferences among the AIIP
participants

• Significantly higher health care costs for
  persons reporting harmful alcohol habits
  according to AUDIT (gt8 and 6 scores)
• Significantly higher health care costs for
  persons having an alcohol dependence diagnosis
• Significantly higher sick leave/disability
  pension costs for females
• A gradually increasing cost difference between
  those who complete the AIIP and those who are
  dismissed

18
ConclusionsIn comparison to controls

• The total costs for sick leave, disability
  pension and in-patient health care costs were 9
  000 SEK (about 1000 ) lower per person and year
  during participation in an AIIP
• This corresponds to 25 lower costs than for the
  controls
• After the 2-year AIIP the costs were still found
  about 2000 SEK lower

19
Final conclusions

• The positive health care effects in the AIIP are
  most probably linked to reduced alcohol
  consumption
• but also to social benefit of being allowed to
  drive while in the AIIP
• The DWI offender pays about 2 500 per year for
  the participation in the AIIP
• which apparently results in about 1 000 lower
  public health care costs per year