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Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
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Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
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Hill SR, Vale L, Hunter D, Henderson E, Oluboyede Y. Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges. Health Policy 2017; 121:1249-1262. [PMID: 29100609 PMCID: PMC5710990 DOI: 10.1016/j.healthpol.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/15/2017] [Accepted: 10/18/2017] [Indexed: 01/31/2023]
Abstract
There are few economic evaluations of alcohol prevention interventions. Consideration of impacts beyond an individual’s health in evaluations is limited. No published studies using other priority-setting methods in the alcohol area. Consideration of wider societal perspectives and health inequalities is minimal. Including inter-sectoral costs and consequences in evaluations is challenging.
Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions. Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006–2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers. 619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified.
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Affiliation(s)
- Sarah R Hill
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - David Hunter
- Centre for Public Policy and Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Emily Henderson
- Centre for Public Policy and Health, School of Medicine, Pharmacy & Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
| | - Yemi Oluboyede
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon-Tyne, NE2 4AX, UK; Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon-Tyne, UK.
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Zur RM, Zaric GS. A microsimulation cost-utility analysis of alcohol screening and brief intervention to reduce heavy alcohol consumption in Canada. Addiction 2016; 111:817-31. [PMID: 26477518 DOI: 10.1111/add.13201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/31/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Screening and brief intervention (SBI) is a public health intervention that has been shown to be effective in reducing heavy alcohol consumption. The aim of this study is to estimate the cost-effectiveness of implementing universal alcohol SBI in primary care in Canada. DESIGN We developed a microsimulation model of alcohol consumption and its effects on 18 alcohol-related causes of death. SETTING The model simulates a Canadian population. PARTICIPANTS The model simulates individuals and their alcohol consumption on a continuous scale starting from age 17 years to death. INTERVENTIONS The reference case assumes no SBI in Canada. The base case assumes screening was conducted using the Alcohol Use Disorders Identification Test (AUDIT) at a threshold score of 8. Additional analyses included evaluating SBI using the AUDIT at threshold scores between 4 and 8 or the Derived Alcohol Use Disorders Identification Test (AUDIT-C) at threshold scores between 3 and 7. MEASUREMENTS The model estimates the direct health-care costs, life years gained and quality-adjusted life years (QALY) gained, which are then used to estimate the incremental cost-effectiveness ratio (ICER) of SBI versus no SBI. FINDINGS SBI with AUDIT (at a threshold score of 8) had an ICER of $8729/QALY. Our results suggest that using AUDIT thresholds between 8 and 4, inclusive, would be cost-effective for the whole population, as well as for men and women individually. Our results suggest that the AUDIT-C would be cost-effective at thresholds of 7 to 3, inclusive, for men, women and the whole population. CONCLUSIONS In Canada, screening and brief intervention via Alcohol Use Disorders Identification Test (AUDIT) and Derived Alcohol Use Disorders Identification Test (AUDIT-C) to reduce heavy alcohol consumption appears to be cost-effective for men and women at Alcohol Use Disorders Identification Test (AUDIT) thresholds of 8 and lower and at Derived Alcohol Use Disorders Identification Test (AUDIT-C) thresholds of 7 and lower.
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Affiliation(s)
- Richard M Zur
- Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.,Optum, Burlington, Ontario, Canada
| | - Gregory S Zaric
- Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.,Epidemiology and Biostatistics, The University of Western Ontario, Ontario, Canada
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Hoang VP, Shanahan M, Shukla N, Perez P, Farrell M, Ritter A. A systematic review of modelling approaches in economic evaluations of health interventions for drug and alcohol problems. BMC Health Serv Res 2016; 16:127. [PMID: 27074871 PMCID: PMC4831174 DOI: 10.1186/s12913-016-1368-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The overarching goal of health policies is to maximize health and societal benefits. Economic evaluations can play a vital role in assessing whether or not such benefits occur. This paper reviews the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to (i) modelling paradigms themselves; (ii) perspectives of costs and benefits and (iii) time frame. Methods Papers that use modelling approaches for economic evaluations of drug and alcohol interventions were identified by carrying out searches of major databases. Results Thirty eight papers met the inclusion criteria. Overall, the cohort Markov models remain the most popular approach, followed by decision trees, Individual based model and System dynamics model (SD). Most of the papers adopted a long term time frame to reflect the long term costs and benefits of health interventions. However, it was fairly common among the reviewed papers to adopt a narrow perspective that only takes into account costs and benefits borne by the health care sector. Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1368-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Van Phuong Hoang
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia.
| | - Marian Shanahan
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Nagesh Shukla
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Pascal Perez
- SMART Infrastructure Facility, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2031, Australia
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Tolchard B. Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service: A pilot study. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Bryant J, Yoong SL, Sanson-Fisher R, Mazza D, Carey M, Walsh J, Bisquera A. Is identification of smoking, risky alcohol consumption and overweight and obesity by General Practitioners improving? A comparison over time. Fam Pract 2015; 32:664-71. [PMID: 26477009 DOI: 10.1093/fampra/cmv078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time. OBJECTIVES To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011. METHODS Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups. RESULTS There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P < 0.0001) and decreased for overweight or obesity from 92% to 89% (P = 0.01). There was a small decrease in the sensitivity of detection of alcohol consumption (P = 0.02) and an increase in specificity (P = 0.01). CONCLUSIONS Despite significant investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients.
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Affiliation(s)
- Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308,
| | - Sze Lin Yoong
- Hunter New England Population Health, c/o Booth Building, Wallsend, NSW 2287
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC 3168 and
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Justin Walsh
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308
| | - Alessandra Bisquera
- Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia
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Rose GL, Ferraro TA, Skelly JM, Badger GJ, MacLean CD, Fazzino TL, Helzer JE. Feasibility of automated pre-screening for lifestyle and behavioral health risk factors in primary care. BMC FAMILY PRACTICE 2015; 16:150. [PMID: 26497902 PMCID: PMC4619079 DOI: 10.1186/s12875-015-0368-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Screening of primary care patients for unhealthy behaviors and mental health issues is recommended by numerous governing bodies internationally, yet evidence suggests that provider-initiated screening is not routine practice. The objective of this study was to implement systematic pre-screening of primary care patients for common preventive health issues on a large scale. METHODS Patients registered for non-acute visits to one of 40 primary care providers from eight clinics in an Academic Medical Center health care network in the United States from May, 2012 to May, 2014 were contacted one- to three-days prior to their visit. Patients were invited to complete a questionnaire using an Interactive Voice Response (IVR) system. Six items assessed pain, smoking, alcohol use, physical activity, concern about weight, and mood. RESULTS The acceptance rate among eligible patients reached by phone was 65.6 %, of which 95.5 % completed the IVR-Screen (N = 8,490; mean age 57; 57 % female). Sample demographics were representative of the overall primary care population from which participants were drawn on gender, race, and insurance status, but participants were slightly older and more likely to be married. Eighty-seven percent of patients screened positive on at least one item, and 59 % endorsed multiple problems. The majority of respondents (64.2 %) reported being never or only somewhat physically active. Weight concern was reported by 43.9 % of respondents, 36.4 % met criteria for unhealthy alcohol use, 23.4 % reported current pain, 19.6 % reported low mood, and 9.4 % reported smoking. CONCLUSIONS The percent endorsement for each behavioral health concern was generally consistent with studies of screening using other methods, and contrasts starkly with the reported low rates of screening and intervention for such concerns in typical PC practice. Results support the feasibility of IVR-based, large-scale pre-appointment behavioral health/ lifestyle risk factor screening of primary care patients. Pre-screening in this population facilitated participation in a controlled trial of brief treatment for unhealthy drinking, and also could be valuable clinically because it allows for case identification and management during routine care.
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Affiliation(s)
- Gail L Rose
- Department of Psychiatry, the University of Vermont, Burlington, VT, USA.
| | - Tonya A Ferraro
- Office of Research Administrative Services, Harvard University, Cambridge, MA, USA.
| | - Joan M Skelly
- Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA.
| | - Gary J Badger
- Department of Medical Biostatistics, The University of Vermont, Burlington, VT, USA.
| | - Charles D MacLean
- Department of Medicine, The University of Vermont, Burlington, VT, USA.
| | - Tera L Fazzino
- Department of Public Health and Preventive Medicine, University of Kansas, Kansas City, 10, USA.
| | - John E Helzer
- Department of Psychiatry, the University of Vermont, Burlington, VT, USA.
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Lander F, Gray D, Wilkes E. The Alcohol Mandatory Treatment Act: evidence, ethics and the law. Med J Aust 2015; 203:47-9. [PMID: 26126570 DOI: 10.5694/mja15.00173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022]
Abstract
The Northern Territory Alcohol Mandatory Treatment Act 2013 (AMT Act) permits mandatory residential alcohol rehabilitation for up to 3 months. International guidelines and human rights law confirm that mandatory rehabilitation should only be used for short periods. Evidence concerning the efficacy of long-term mandatory alcohol rehabilitation is lacking, and minimal data concerning the efficacy of the scheme have been released. Specific legal issues also arise concerning the AMT Act, including its potentially discriminatory application to Aboriginal and Torres Strait Islander peoples. The program only permits referral by police, despite the fact that it is ostensibly a medical intervention. Use of a treatment as a method of effectively solving a public intoxication problem is highly dubious, and should be of concern to the medical community. Given that more cost-effective and proven measures exist to combat alcohol dependence, the utility of the AMT Act is questionable.
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Affiliation(s)
- Fiona Lander
- Harvard T.H. Chan School of Public Health, Boston, Mass, USA.
| | - Dennis Gray
- National Drug Research Institute, Curtin University of Technology, Perth, WA, Australia
| | - Edward Wilkes
- National Drug Research Institute, Curtin University of Technology, Perth, WA, Australia
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Sutton L, Karan A, Mahal A. Evidence for cost-effectiveness of lifestyle primary preventions for cardiovascular disease in the Asia-Pacific Region: a systematic review. Global Health 2014; 10:79. [PMID: 25406936 PMCID: PMC4251847 DOI: 10.1186/s12992-014-0079-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022] Open
Abstract
Background Countries of the Asia Pacific region account for a major share of the global burden of disease due to cardiovascular disease (CVD) and this burden is rising over time. Modifiable behavioural risk factors for CVD are considered a key target for reduction in incidence but their effectiveness and cost-effectiveness tend to depend on country context. However, no systematic assessment of cost-effectiveness of interventions addressing behavioural risk factors in the region exists. Methods A systematic review of the published literature on cost-effectiveness of interventions targeting modifiable behavioural risk factors for CVD was undertaken. Inclusion criteria were (a) countries in Asia and the Pacific, (b) studies that had conducted economic evaluations of interventions (c) published papers in major economic and public health databases and (d) a comprehensive list of search words to identify appropriate articles. All authors independently examined the final list of articles relating to methodology and findings. Results Under our inclusion criteria a total of 28 studies, with baseline years ranging from 1990 to 2012, were included in the review, 19 conducted in high-income countries of the region. Reviewed studies assessed cost-effectiveness of interventions for tobacco control, alcohol reduction, salt intake control, physical activity and dietary interventions. The majority of cost-effectiveness analyses were simulation analyses mostly relying on developed country data, and only 6 studies used effectiveness data from RCTs in the region. Other than for Australia, no direct conclusions could be drawn about cost-effectiveness of interventions targeting behavioural risk factors due to the small number of studies, interventions that varied widely in design, and varied methods for measurement of costs associated with interventions. Conclusions Good quality cost-effectiveness information on interventions targeting behavioural interventions for the Asia-Pacific region remains a major gap in the literature. Electronic supplementary material The online version of this article (doi:10.1186/s12992-014-0079-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lainie Sutton
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Anup Karan
- Indian Institute of Public Health Gandhinagar (IIPHG), Sardar Patel Institute Campus, Thaltej, Ahmedabad, 380 054, India. .,Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Ajay Mahal
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
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Angus C, Latimer N, Preston L, Li J, Purshouse R. What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care. Front Psychiatry 2014; 5:114. [PMID: 25225487 PMCID: PMC4150206 DOI: 10.3389/fpsyt.2014.00114] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered. METHODS Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations. RESULTS The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result. CONCLUSION This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nicholas Latimer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jessica Li
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Robin Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Agley J, McIntire R, DeSalle M, Tidd D, Wolf J, Gassman R. Connecting patients to services: Screening, brief intervention and referral to treatment in primary health care. DRUGS-EDUCATION PREVENTION AND POLICY 2014. [DOI: 10.3109/09687637.2014.899992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shakeshaft A, Doran C, Petrie D, Breen C, Havard A, Abudeen A, Harwood E, Clifford A, D'Este C, Gilmour S, Sanson-Fisher R. The effectiveness of community action in reducing risky alcohol consumption and harm: a cluster randomised controlled trial. PLoS Med 2014; 11:e1001617. [PMID: 24618831 PMCID: PMC3949675 DOI: 10.1371/journal.pmed.1001617] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data. METHODS AND FINDINGS We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000-20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department-based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001-2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = -3.37 to -0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates. CONCLUSIONS This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12607000123448.
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Affiliation(s)
- Anthony Shakeshaft
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Christopher Doran
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dennis Petrie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Ansari Abudeen
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Elissa Harwood
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Anton Clifford
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
- Institute for Urban Indigenous Health, Bowen Hills, Queensland, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Stuart Gilmour
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Breen C, Shakeshaft A, Sanson-Fisher R, D'Este C, Mattick RP, Gilmour S. Identifying individual- and population-level characteristics that influence rates of risky alcohol consumption in regional communities. Aust N Z J Public Health 2014; 38:60-5. [DOI: 10.1111/1753-6405.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/01/2013] [Accepted: 11/01/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Courtney Breen
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, New South Wales
| | - Catherine D'Este
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, New South Wales
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, School of Public Health and Community Medicine, University of New South Wales
| | - Stuart Gilmour
- Department of Global Health Policy, University of Tokyo, Japan
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Bray JW, Zarkin GA, Hinde JM, Mills MJ. Costs of alcohol screening and brief intervention in medical settings: a review of the literature. J Stud Alcohol Drugs 2013; 73:911-9. [PMID: 23036208 DOI: 10.15288/jsad.2012.73.911] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This article summarizes the literature on the implementation costs of alcohol screening and brief intervention (SBI) in medical settings. METHOD Electronic databases were searched using SBI- and cost-related terms. Methodological approaches and cost estimates were abstracted from each study and categorized based on the cost methodology. Costs were updated to 2009 U.S. dollars. To determine a summary cost measure, we excluded outliers and computed the median of the remaining cost estimates. RESULTS Seventeen studies with cost estimates were identified for further study. Costs ranged from $0.51 to $601.50 per screen and from $3.41 to $243.01 per brief intervention (BI). Cost estimates were lower when an activity-based cost methodology was used, in primary care settings, and when the provider was not a doctor. The median summary cost of a screen is approximately $4, and the median summary cost of a BI is approximately $48. CONCLUSIONS Screening cost estimates had more variation than BI cost estimates. Provider type and service delivery time drive the cost variation. Interpretation of cost differences was limited by insufficient reporting of the cost methodology. Cost estimates presented here are similar in size to the Healthcare Common Procedure Coding System and Current Procedural Terminology reimbursement amounts, suggesting that insurance-based service reimbursement may be sufficient to sustain alcohol SBI in practice.
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Affiliation(s)
- Jeremy W Bray
- RTI International, Research Triangle Park, North Carolina.
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