Department of Primary Care and Population Health, University College London, London, UK.
Regional Centre for Training in Primary Care, Monfalcone, Gorizia, Italy.
BMJ Open. 2017 Nov 3;7(11):e014577. doi: 10.1136/bmjopen-2016-014577.
To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI).
Randomised 1:1 non-inferiority trial.
Practices of 58 general practitioners (GPs) in Italy.
Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial.
Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access).
The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months.
The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI -0.007 to 0.011).
Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking.
NCT01638338;Post-results.
评估与标准面对面简短干预（BI）相比，为意大利国家卫生服务提供方便获取网站的机会对危险饮酒者的 12 个月成本和获得的质量调整生命年（QALYs）的影响。
随机 1:1 非劣效性试验。
意大利 58 名全科医生（GP）的实践。
在 9080 名接受试验的患者中（年龄>18 岁），4529 名（49.9%）登录到网站，3841 名（84.8%）接受了在线危险饮酒筛查。822 名（21.4%）筛查阳性，763 名（19.9%）被招募入组。
患者被随机分配接受面对面 BI 或通过 GP 的小册子获得减少酒精摄入的网站（方便访问）。
主要结果是方便访问的每获得一个 QALY 的成本与面对面 BI 的成本相比。二次分析包括每 100 名患者的总成本和效益，包括 12 个月时预防的危险饮酒者人数。
面对面 BI 所需的平均时间为 8 分钟（95%CI 7.5 分钟至 8.6 分钟）。考虑到方便访问的最长时间为 5 分钟，面对面额外增加了 3 分钟：相当于每向网站转诊三名患者，就有时间再安排另一名 GP 预约。在调整基线的情况下，完全案例分析显示，方便访问的 QALY 差异为每名患者 0.002 QALY（95%CI -0.007 至 0.011）。
与 GP 提供的面对面 BI 相比，方便获取网站以减少危险饮酒的成本更低，且结果没有恶化。方便访问的成本较低，特别是在时间投资方面，可能有助于增加对危险饮酒者的 BI 提供。
NCT01638338；结果后注册。
