Abstract
BackgroundSubstance use disorders (SUDs) contribute significantly to global rates of morbidity and mortality. Internet- and mobile-based interventions (IMIs) have been suggested as an adjunct to face-to-face health services. However, the evidence for the cost-effectiveness of IMIs for SUDs is scant.MethodsA comprehensive literature search in PubMed, PsycINFO, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database and EconLit was conducted. We included economic evaluations alongside randomized controlled trials of IMIs for SUDs compared with a control group.ResultsOf 1687 abstracts identified, 11 studies met the inclusion criteria. Targeted conditions were alcohol use disorder (four studies) and tobacco smoking (five studies) whereas two studies included any SUD. Cost-effectiveness results demonstrated that IMIs had a firm probability of being more cost-effective than TAU (e.g. less costs per additional abstinent person). Compared with (online) psycho-education, evidence towards an additional benefit of IMIs was less clear. Regarding cost-utility (e.g. costs per quality-adjusted life year gained), except for one study, results suggested that TAU and online psycho-education would probably be more preferable than IMIs. Quality of study reporting was at least adequate.ConclusionsThe likelihood of IMIs being more cost-effective than TAU looks promising but more economic evaluations are needed in order to determine the economic merit of IMIs. With an increasing pressure on health care budgets, strategies to disseminate effective interventions at affordable costs are required. This review suggests that IMIs might carry that promise and have potential as a cost-effective strategy to scale-up existing evidence-based treatments for SUDs.Systematic review registrationThe systematic review has been registered in the PROSPERO database (no. CRD42018099486).
Highlights
Substance use disorders (SUDs) including tobacco and alcohol contribute significantly to global rates of morbidity and mortality.1 Estimated 12-month prevalence of alcohol use disorder range from 11.8% in European regions2 to 12.7% in the US population.3 The hazardous and harmful use of alcohol is a global problem, contributing 4.6% of the total global burden of disease, with the highest rates reported in the European and American regions (17.3% and 14.2%, respectively).4 In 2014, overall prevalence rates of tobacco smoking were estimated at 27.2% in Europe.5 Tobacco smoking is a major preventable cause of death in both developed and developing countries.6 Smoking imposes a huge economic burden on society—currently up to 15% of the total healthcare costs in developed countries
The aim of this review was to provide an overview of trial-based health-economic evaluation studies of Internet- and mobile-based interventions (IMIs)
for SUD compared with control conditions
Summary
Substance use disorders (SUDs) including tobacco and alcohol contribute significantly to global rates of morbidity and mortality. Estimated 12-month prevalence of alcohol use disorder range from 11.8% in European regions to 12.7% in the US population. The hazardous and harmful use of alcohol is a global problem, contributing 4.6% of the total global burden of disease, with the highest rates reported in the European and American regions (17.3% and 14.2%, respectively). In 2014, overall prevalence rates of tobacco smoking were estimated at 27.2% in Europe. Tobacco smoking is a major preventable cause of death in both developed and developing countries. Smoking imposes a huge economic burden on society—currently up to 15% of the total healthcare costs in developed countries.. Substance use disorders (SUDs) including tobacco and alcohol contribute significantly to global rates of morbidity and mortality.. Substance use disorders (SUDs) contribute significantly to global rates of morbidity and mortality. Targeted conditions were alcohol use disorder (four studies) and tobacco smoking (five studies) whereas two studies included any SUD. Regarding cost-utility (e.g. costs per quality-adjusted life year gained), except for one study, results suggested that TAU and online psycho-education would probably be more preferable than IMIs. Quality of study reporting was at least adequate. This review suggests that IMIs might carry that promise and have potential as a cost-effective strategy to scale-up existing evidence-based treatments for SUDs. Systematic review registration: The systematic review has been registered in the PROSPERO database
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