Solberg Leif I, Maciosek Michael V, Edwards Nichol M
HealthPartners Research Foundation, Minneapolis, Minnesota 55440-1524, USA.
Am J Prev Med. 2008 Feb;34(2):143-152. doi: 10.1016/j.amepre.2007.09.035.
The U.S. Preventive Services Task Force (USPSTF) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse. This study was designed to develop a standardized rating for the clinically preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services.
A systematic review of the literature from 1992 through 2004 to identify relevant randomized controlled trials and cost-effectiveness studies was completed in 2005. Clinically preventable burden (CPB) was calculated as the product of effectiveness times the alcohol-attributable fraction of both mortality and morbidity (measured in quality-adjusted life years or QALYs), for all relevant conditions. Cost effectiveness from both the societal perspective and the health-system perspective was estimated. These analyses were completed in 2006.
The calculated CPB was 176,000 QALYs saved over the lifetime of a birth cohort of 4,000,000, with a range in sensitivity analysis from -43% to +94% (primarily due to variation in estimates of effectiveness). Screening and brief counseling was cost-saving from the societal perspective and had a cost-effectiveness ratio of $1755/QALY saved from the health-system perspective. Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving.
These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using standardized methods. Since current levels of delivery are the lowest of comparably ranked services, this service deserves special attention by clinicians and care delivery systems.
美国预防服务工作组（USPSTF）建议在初级保健中进行筛查和行为咨询干预，以减少酒精滥用。本研究旨在为遵循该建议的临床可预防负担和成本效益制定标准化评级，以便能够对众多推荐服务进行比较。
2005年完成了对1992年至2004年文献的系统综述，以确定相关的随机对照试验和成本效益研究。临床可预防负担（CPB）计算为所有相关疾病的有效性乘以死亡率和发病率的酒精归因比例（以质量调整生命年或QALY衡量）的乘积。从社会角度和卫生系统角度估计了成本效益。这些分析于2006年完成。
在400万出生队列的一生中，计算出的CPB为节省了176,000个QALY，敏感性分析范围为-43%至+94%（主要由于有效性估计的差异）。从社会角度来看，筛查和简短咨询具有成本节约效果，从卫生系统角度来看，成本效益比为每节省一个QALY花费1755美元。敏感性分析表明，从两个角度来看，该服务都具有很高的成本效益，甚至可能具有成本节约效果。
这些结果使酒精筛查和咨询成为使用标准化方法评估的25项有效服务中排名最高的预防服务之一。由于目前的服务提供水平在同等排名的服务中是最低的，因此该服务值得临床医生和医疗服务提供系统给予特别关注。
