Examining the 24/7 Sobriety Program in South Dakota, which started as a pilot in 2005, researchers found that county implementation of the program was associated with a 4 percent drop in deaths at the county level.
The South Dakota 24/7 Sobriety Program requires that individuals with an alcohol-involved offense undergo twice-a-day breathalyzer tests, typically once in the morning and once in the evening, or wear continuous alcohol monitoring bracelets. Individuals who fail or skip required tests are immediately subject to a short jail term, typically a day or two for a failed test.
Nearly 17,000 individuals — nearly 3 percent of the state’s adult population — participated in the 24/7 program between January 2005 and June 2011. Nearly half of the participants were enrolled after a repeat DUI offense, while others were enrolled after a first-time DUI offence or being charged with assault or domestic violence….
To examine whether the program was associated with changes in mortality, researchers analyzed county-level mortality data from January 2000 through June 2011, and took advantage of the fact that counties implemented the strategy at different points in time…..
The association was evident not only for total deaths, but also among conditions sensitive to alcohol use, including circulatory conditions.
Mark Kleiman ( a big supporter of 24/7 Sobriety and more generally swift/certain/small punishment regimes) at Vox makes another point on cost effectiveness:
The program costs less than $2 per participant per day; offenders are required to bear that cost, presumably out of the money they would otherwise spend on alcohol.
Doing some very quick back of the envelope calculations, this is a $12 million dollar a year program at most ($2 per day per participant *17,000*365). It works out to be a public health investment of no less than a penny per person per week. This is a massive overestimate as the program was evaluated over a six year period and people came in and out of the program. But let’s stick with $12 million as the worst case scenario is massive illuminating anyways.
The program only had to avoid two deaths per year or add 120 QALY improvements to be cost effective as a public health measure. If the 4% reduction in mortality runs through verification, the averted deaths are orders of magnitude higher than the minimal needed to be a break even proposition.
This is an extreme example of how public health programs can be used to divert medical expenses. South Dakota’s hospitals are most likely seeing a healthier population than they otherwise would have been seeing. There would be fewer car crashes, fewer cirrhosis cases, fewer cardiovascular failures than the counterfactual of having drunk drivers still drinking. Substance abuse is a known cost driver in risk adjustment, and it is often a co-morbidity multiplier where it makes treating other issues harder and more expensive. From a public health perspective society paying a few pennies per person per month for this type of public health intervention is a massive win.
It is a win at the immediate outcome level, and it is a win at avoiding sending people to limited detox and rehab beds at $1,000 or more per bed per night.