New alcohol biomarker test lowers the cost of caring for patients with chronic illnesses

Adding a new alcohol biomarker test to patients' revelations about their drinking habits could lower the cost of caring for patients with chronic illnesses like diabetes and high blood pressure, a health economics analysis finds.

The alcohol-screening test measures the level of a chemical in the blood - carbohydrate deficient transferrin - which is responsive to alcohol. A cost-benefit analysis by Michael Fleming, M.D., and colleagues found that the CDT test increases the number of problem drinkers detected in a population of primary care patients.

The benefit-cost model - which uses data from surveys, published literature and two trials - is published in the November edition of the journal Alcoholism: Clinical and Experimental Research. The analysis estimates that CDT testing results in $212.30 in overall savings per patient by avoiding some medical and legal costs.

The alcohol biomarker is approved by the U.S. Food and Drug Administration, but Fleming said that many primary care physicians do not know about the CDT technology.

CDT is not a test for alcoholism; it can't judge whether a patient is dependent on alcohol, Fleming said. But the test can detect if a patient has consumed four to five alcoholic drinks a day within the last two weeks.

Once harmful drinking is identified through a CDT test, Fleming said a physician can try to rein in a patient's heavy alcohol consumption.

Heavy drinking can worsen illnesses like high blood pressure, diabetes and heart disease. Excessive alcohol consumption can also interfere with medications commonly prescribed for those conditions.

Peter Miller, a researcher at the Center for Drug and Alcohol Programs at the Medical University of South Carolina, is working to encourage more physicians to consider CDT in their care of patients who have alcohol-sensitive illnesses.

"You'd begin with a self-report questionnaire and then you might use the test for patients you suspect are heavier drinkers than they are admitting to," Miller said. "It's a more objective test that can corroborate what a patient or his family is saying."

Miller said the CDT test is especially helpful when a patient has received proper treatment and made lifestyle changes, but his or her condition is still not under control. A patient who is taking three medicines for hypertension might be able to control the condition with one drug, Miller said, after a CDT test confirms excessive alcohol consumption and the patient cuts back on alcohol use.

Miller was not involved in the CDT cost-benefit study from Fleming and his colleagues.

Today Medicare reimburses about $26 for the CDT test, Fleming said. But laboratory analysis of the blood test is not uniformly available across the United States.

Cost savings came mainly from decreases in hospitalization, fewer accidents and trauma incidents as well as a reduction in emergency room visits, Fleming said. Those economic benefits are realized within about four years after the test, the analysis estimates.

"Compared to other things - like bypass surgery or (the cholesterol-lowering drug) Lipitor - 48 months isn't a long time to get some kind of payoff," Fleming said. "That's a benefit for a company that has a long-term commitment to a patient – it may not be for a patient that's changing insurance companies every year," he said.