School of Health and Related Research, University of Sheffield, Sheffield, UK.
Department of Health Sciences, University of York, York, UK.
Eur J Public Health. 2019 Apr 1;29(2):219-225. doi: 10.1093/eurpub/cky181.
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.
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).
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).
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.
ClinicalTrials.gov trial identifier: NCT01501552.
针对重度饮酒的筛查和简短干预（SBIs）是减少与酒精相关伤害的有效且具有成本效益的方法，但实施率仍然很低。本研究使用试验数据来估计增加 SBI 实施的替代策略的成本效益。
将来自一项大型集群随机试验的数据与谢菲尔德酒精政策模型（一种政策评估工具）相结合，以估计在英格兰、波兰和荷兰的初级保健中增加 SBI 实施的八种策略的成本效益：常规护理（对照）、培训和支持（TS）、财务报销（FR）、将患者转介到在线简短干预（eBI）以及 TS、FR 和 eBI 的所有组合。从医疗保健角度评估成本效益，通过比较每种策略在 30 年期间的健康效益（以质量调整生命年来衡量）与总实施成本和下游医疗保健节省，并计算增量成本效益比（ICER）。
与对照相比，所有试验策略均具有成本效益。TS 与 FR 联合在英格兰（比对照更有效且成本更低）和波兰（ICER 为 4632 欧元与下一个最佳策略相比）是最具成本效益的方法。在荷兰，这种组合不具有成本效益，TS 单独是最具成本效益的方法（ICER 为 3386 欧元与下一个最佳策略相比）。
结构化的 TS、财务激励和在线干预的获取均被估计为改善酒精简短干预实施的具有成本效益的方法。TS 和 FR 一起可能是最具成本效益的方法，但这取决于国家特点和替代 BI 效果假设。
ClinicalTrials.gov 试验标识符：NCT01501552。
