Abstract
BackgroundInternet interventions with and without therapist support have been found to be effective treatment options for harmful alcohol users. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS), but it is also more costly to provide.ObjectiveTo evaluate the cost effectiveness and cost utility of Internet-based interventions for harmful use of alcohol through the assessment of the incremental cost effectiveness of IT compared with IS.MethodsThis study was performed in a substance abuse treatment center in Amsterdam, the Netherlands. We collected data over the years 2008–2009. A total of 136 participants were included, 70 (51%) were female, and mean age was 41.5 (SD 9.83) years. Reported alcohol consumption and Alcohol Use Disorders Identification Test (AUDIT) scores indicated harmful drinking behavior at baseline. We collected self-reported outcome data prospectively at baseline and 6 months after randomization. Cost data were extracted from the treatment center’s cost records, and sex- and age-specific mean productivity cost data for the Netherlands.ResultsThe median incremental cost-effectiveness ratio was estimated at €3683 per additional treatment responder and €14,710 per quality-adjusted life-year (QALY) gained. At a willingness to pay €20,000 for 1 additional QALY, IT had a 60% likelihood of being more cost effective than IS. Sensitivity analyses attested to the robustness of the findings.ConclusionsIT offers better value for money than IS and might therefore be considered as a treatment option, either as first-line treatment in a matched-care approach or as a second-line treatment in the context of a stepped-care approach.Trial RegistrationNetherlands Trial Register NTR-TC1155; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1155 (Archived by WebCite at http://www.webcitation.org/6AqnV4eTU)
Highlights
Harmful alcohol use is the number-3 leading contributor to global burden of disease [1] and causes 3.8% of global mortality [2], as well as losses in gross domestic product [3]
Of the 136 participants included in this cost effectiveness analysis, 68 were randomly assigned to Internet-based therapy (IT) and 68 to Internet-based self-help (IS)
We found that incremental cost effectiveness ratio (ICER) were more sensitive to changes in productivity losses than to changes in intervention costs
Summary
Harmful alcohol use is the number-3 leading contributor to global burden of disease [1] and causes 3.8% of global mortality [2], as well as losses in gross domestic product [3]. Internet interventions with and without therapist support [5-8] have been found to be effective treatment options for harmful alcohol users and could perhaps be used sequentially in a stepped-care format. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS) in the treatment of depression [9,10], anxiety [10,11], and problem drinking [8]. Studies have been published on the cost effectiveness of Internet-based (self-help) interventions for depression [12], weight management [13], and harmful alcohol use [14]. Internet interventions with and without therapist support have been found to be effective treatment options for harmful alcohol users. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS), but it is more costly to provide
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