Abstract
Introduction: The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered.Methods: Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations.Results: The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result.Conclusion: This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.
Highlights
The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; evidence on their cost-effectiveness is limited
This review provides strong evidence that Screening and Brief Interventions (SBIs) programs in primary care are a cost-effective option for tackling alcohol misuse
SBI delivered at general practitioners (GPs) registration has an Incremental Cost–Effectiveness Ratio (ICER) of C550 per QALY vs. do-nothing
Summary
The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; evidence on their cost-effectiveness is limited. The misuse of alcohol is a substantial concern for public health policy makers across the world, with over 5% of the global burden of disease and injury estimated as being alcohol-attributable (1). In addition to these deleterious effects on health and the associated economic costs, excessive consumption of alcohol is associated with a range of social harms such as increased crime, public nuisance, and reduced workplace productivity, which impact not just on the drinker, but on society as a whole (2). This is a key question for the policy makers and healthcare budget planners being urged to instigate or fund these programs and there have been few attempts to draw together the existing literature in order to inform their decisions
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