A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits

Silvia Maa Evers,Astrid F Jander,Aggie Tg Paulus,Liesbeth Mercken,Dirk Ruwaard,Hein De Vries,Ruben Mwa Drost

doi:10.2196/jmir.5223

Abstract

BackgroundPreventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs).ObjectiveThe aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs).MethodsData used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity.ResultsFrom both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups.ConclusionsComputer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups.Trial RegistrationNederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG)

Highlights

Excessive alcohol use and alcohol use disorders are major causes of death and disability worldwide [1,2,3,4]
Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents
Including intersectoral costs and benefits (ICBs) in the economic evaluation had an impact on the cost-effectiveness results of the analysis

Summary

Introduction

Excessive alcohol use and alcohol use disorders are major causes of death and disability worldwide [1,2,3,4]. In the European Union alone, alcohol-attributable costs were estimated at €125 billion in 2003 [4] These encompass health care services, such as hospitalizations, home health care, and ambulatory care, and costs outside the health care sector, such as costs resulting from productivity losses and costs in the criminal justice system. Examples of the latter include vehicle crashes, increased crime, and arrests. Preventing excessive alcohol use among adolescents is important to foster individual and public health, and to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, known as intersectoral costs and benefits (ICBs)

Methods

Results

Conclusion