Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care

Luqman Tariq,Matthijs Van Den Berg,Pieter H M Van Baal,Rudolf T Hoogenveen,Syed Ahmer

doi:10.1371/journal.pone.0005696

Luqman Tariq, Matthijs Van Den Berg + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0005696

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Abstract

BackgroundEffective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers.Methodology and ResultsWe compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of €298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of €5,400 per QALY gained.ConclusionPrevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective.

Highlights

Excessive alcohol use is a cause of morbidity and even mortality, as it increases risks of coronary heart disease, stroke, and several types of cancers, with associated losses of life-years and quality of life [1,2,3]
In the Netherlands, about 1% of total mortality, 4.5% of the public burden of disease and 0.6% of total health care costs can be attributed to chronic diseases caused by excessive alcohol consumption [5]
In the Screening and Brief Intervention (SBI) scenario the reduction in alcohol consumption results in a decrease in the incidence of alcohol related diseases, and in a decrease in health care costs of these diseases. This causes a gain in life years and Quality Adjusted Life Years (QALYs) compared to current practice scenario

Summary

Introduction

Excessive alcohol use is a cause of morbidity and even mortality, as it increases risks of coronary heart disease, stroke, and several types of cancers, with associated losses of life-years and quality of life [1,2,3]. Effective prevention of excessive alcohol use has the potential to reduce the burden of disease in the Netherlands considerably. The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking. Sensitivity of this questionnaire ranged from 51% to 97%, while specificity ranged from 78% to 96%. While screening would be opportunistic and not targeted at any group brief intervention is targeted at groups with a high risk to be(come) an excessive drinker in primary care. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers

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