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Cost-effectiveness of strategies to improve delivery of brief interventions for heavy drinking in primary care: results from the ODHIN trial

Lookup NU author(s): Professor Peter Anderson

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2019.

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Abstract

© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. BACKGROUND: Screening and brief interventions (SBIs) for heavy drinking are an effective and cost-effective approach to reducing alcohol-related harm, yet delivery rates remain low. This study uses trial data to estimate the cost-effectiveness of alternative strategies to increase SBI delivery. METHODS: Data from a large cluster-randomized trial were combined with the Sheffield Alcohol Policy Model, a policy appraisal tool, to estimate the cost-effectiveness of eight strategies to increase SBI delivery in primary care in England, Poland and the Netherlands: care as usual (control), training and support (TS), financial reimbursement (FR), referral of patients to an online brief intervention (eBI) and all combinations of TS, FR and eBI. cost-effectiveness was assessed from a healthcare perspective by comparing health benefits (measured in Quality-Adjusted Life Years) with total implementation costs and downstream healthcare savings for each strategy over a 30-year horizon and calculating Incremental cost-effectiveness ratios (ICERs). RESULTS: All trialled strategies were cost-effective compared to control. TS combined with FR was the most cost-effective approach in England (more effective and less costly than control) and Poland (ICER €4632 vs. next-best strategy). This combination is not cost-effective in the Netherlands, where TS alone is the most cost-effective approach (ICER €3386 vs. next-best strategy). CONCLUSIONS: Structured TS, financial incentives and access to online interventions are all estimated to be cost-effective methods of improving delivery of alcohol brief interventions. TS and FR together may be the most cost-effective approach, however this is sensitive to country characteristics and alternative BI effect assumptions. TRIAL REGISTRATION: ClinicalTrials.gov trial identifier: NCT01501552.

Publication metadata

Author(s): Angus C, Li J, Romero-Rodriguez E, Anderson P, Parrott S, Brennan A

Publication type: Article

Publication status: Published

Journal: European Journal of Public Health

Year: 2019

Volume: 29

Issue: 2

Pages: 219-225

Print publication date: 01/04/2019

Online publication date: 17/09/2018

Acceptance date: 02/04/2018

Date deposited: 09/04/2019

ISSN (print): 1101-1262

ISSN (electronic): 1464-360X

Publisher: Oxford University Press

URL: https://doi.org/10.1093/eurpub/cky181

DOI: 10.1093/eurpub/cky181

PubMed id: 30239676

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