Cost Of Such Interventions Research Articles

Quantifying the Effect of Quarantine Control and Optimizing Its Cost in COVID-19 Pandemic.

The novel coronavirus has been spreading worldwide and emerged as a public health crisis. As the rapid rise of infected population count, a wide variety of stringent non-pharmaceutical interventions have been taken by cities and countries around the globe, including mobility reduction, social distancing and regional lockdown. The efficacy of these interventions is hard to quantify as individuals violate policies, travel inadvertently or deliberately, and spread the virus without themselves being infected. Furthermore, the publicly available pandemic data on infectious rates and other epidemiological data are unreliable and limited, and are even underestimated. In this paper, we intend to interpret and forecast the spreading dynamics of Covid-19 and quantify the efficacy of quarantine control adopted by Wuhan, Italy, South Korea and the United States of America, employing a hybrid model of an epidemiological model and a data-driven neural network model. Furthermore, since the Covid-19 has prompted global travel restrictions, aggravated unemployment, and influenced the global economy, which exemplify the great societal cost of interventions in the battle of halting Covid-19 spreading. We intend to develop optimal quarantine control under which the tradeoff between Covid-19 containment and the societal cost of quarantine control can be optimized. Optimal quarantine control enables communities have opportunities to catch their breath to reserve healthcare resources preemptively, while the Covid-19 spreading can be halted. Our results unequivocally indicate that governments that taken stringent interventions starting from the initial stage can efficiently halt the spreading of Covid-19; furthermore, the total societal cost of such interventions is greatly smaller.

THE EFFECTIVENESS OF INTERNET-BASED INTERVENTIONS IN REDUCING STRESS EXPERIENCED BY OLDER INFORMAL CAREGIVERS

Abstract Purpose This systematic review assesses and provides a critical review of the effectiveness of internet-based interventions to decrease informal caregiver stress. Method: A systematic review of the following databases: PsycINFO, Social Service Abstract, Social Work Abstract, PubMed, and Cochrane Library was conducted using terms related to informal caregivers and internet-based interventions from January 2010-February 2022. Only data conducting interventions in the U.S. included. This systematic review reviewed the quality of articles on the methods of randomized and non-randomized trials using the approaches recommended by the Cochrane Handbook for systematic review for intervention. The review was reported using a PRISMA chart. Results Eight studies met the review criteria. Most of the studies showed positive benefits in reducing caregiver stress. There were no clear patterns as to the variables such as study duration and complexity of intervention associated with better outcomes, although earlier studies typically had more negative outcomes. Conclusions Internet-based interventions can develop solutions to decrease the physical and psychological consequences resulting from caregiving and can help empower older caregivers of people with chronic diseases. Internet-based interventions were mainly effective in reducing aspects of caregiver stress and improving their well-being. Further studies can assess outcomes for older informal caregivers and their recipients’ health, different technology delivery methods, and the cost of such interventions are needed to examine the psychological impacts of COVID-19 on older informal caregivers.

Economic evaluation of legislation-based public health interventions – the case of tobacco control

Abstract Economic evaluation of public health interventions have mostly been performed for interventions whose cost and effectiveness can be well identified, such as protective interventions (vaccination or screening), clinical interventions (prevention drugs) or counselling and education programs. Yet, following the Thomas Frieden's health impact pyramid, these public health interventions are less effective than those “changing the context to make individuals’ default decision healthy”. The economic evaluation of population-based interventions that modify the context is rather challenging. First, such interventions include various components, e.g., taxes and subsidies, media campaigns or bans. Second, since they correspond to political decisions applied at a wide scale, their effectiveness can hardly be measured using experimental designs. Third, the cost of such interventions is difficult to assess, since they are not represented by a specific product or service, but rather by political decisions and their implementation, whose costing is not straightforward. Using the case of tobacco control policies, we show how alternative methods can be used to assess their economic value. We show that quasi-experimental methods with country comparisons allow identify the effectiveness of specific policies, and that qualitative approaches are needed to quantify their costs. Results indicate that tobacco-control policies have low costs and are highly effective, so that their cost-effectiveness is quite favorable in light of commonly referred thresholds, and in comparison with widely financed clinical interventions. Population-based interventions that focus contextual factors must also be carefully evaluated from an economic viewpoint. Although economic evaluations are challenging, alternative approaches help obtain results that are valuable for decision making.

Evaluation of evidence supporting NICE recommendations to change people's lifestyle in clinical practice: cross sectional survey

ObjectivesTo assess whether recommendations of individually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether...

Recent Insights into the Management of Pleural Infection.

Pleural infection in adults has considerable morbidity and continues to be a life-threatening condition. The term “pleural infection” encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Management of pleural infection requires prolonged duration of hospitalization (average 14 days). There are recognized differences in microbial etiology of pleural infection depending on whether the infection was acquired in the community or in a health-care setting. Anaerobic bacteria are acknowledged as a major cause of pleural infection, and thus anaerobic coverage in antibiotic regimens for pleural infection is mandatory. The key components of managing pleural infection are appropriate antimicrobial therapy and chest-tube drainage. In patients who fail medical therapy by manifesting persistent sepsis despite standard measures, surgical intervention to clear the infected space or intrapleural fibrinolytic therapy (in poor surgical candidates) are recommended. Recent studies have explored the role of early intrapleural fibrinolytics or first-line surgery, but due to considerable costs of such interventions and the lack of convincing evidence of improved outcomes with early use, early intervention cannot be recommended, and further evidence is awaited from ongoing studies. Other areas of research include the role of routine molecular testing of infected pleural fluid in improving the rate of identification of causative organisms. Other research topics include the benefit of such interventions as medical thoracoscopy, high-volume pleural irrigation with saline/antiseptic solution, and repeated thoracentesis (as opposed to chest-tube drainage) in reducing morbidity and improving outcomes of pleural infection. This review summarizes current knowledge and practice in managing pleural infection and future research directions.

Skeletal Muscle in Cerebral Palsy: From Belly to Myofibril.

This review will provide a comprehensive, up-to-date review of the current knowledge regarding the pathophysiology of muscle contractures in cerebral palsy. Although much has been known about the clinical manifestations of both dynamic and static muscle contractures, until recently, little was known about the underlying mechanisms for the development of such contractures. In particular, recent basic science and imaging studies have reported an upregulation of collagen content associated with muscle stiffness. Paradoxically, contractile elements such as myofibrils have been found to be highly elastic, possibly an adaptation to a muscle that is under significant in vivo tension. Sarcomeres have also been reported to be excessively long, likely responsible for the poor force generating capacity and underlying weakness seen in children with cerebral palsy (CP). Overall muscle volume and length have been found to be decreased in CP, likely secondary to abnormalities in sarcomerogenesis. Recent animal and clinical work has suggested that the use of botulinum toxin for spasticity management has been shown to increase muscle atrophy and fibrofatty content in the CP muscle. Given that the CP muscle is short and small already, this calls into question the use of such agents for spasticity management given the functional and histological cost of such interventions. Recent theories involving muscle homeostasis, epigenetic mechanisms, and inflammatory mediators of regulation have added to our emerging understanding of this complicated area.

A transferable method for estimating the economic impacts of track interventions: Application to ground-borne noise reduction measures for whole sections of route

The environmental impacts of noise and vibration are becoming increasingly important in the assessment of new and upgraded railway routes. Vibration from railways propagates through the ground to nearby buildings where it may cause annoyance as feelable vibration or as re-radiated noise. To tackle the adverse effects of ground-borne noise a range of possible interventions are available, including softer rail pads, under-sleeper pads and under-ballast mats. The installation costs of such interventions are generally higher for the higher-performing track types. Additionally, there are potential effects on track maintenance costs which may be positive or negative, for example by reducing sleeper damage or increasing the need for ballast tamping. This study presents a socio-economic analysis of the effects of several interventions to reduce ground-borne noise. By selecting a whole route, the installation and whole-life costs are assessed using Network Rail’s Vehicle-Track Interaction Strategic Model (VTISM) and these are offset against benefits in terms of reduced social costs. Ground-borne noise is predicted at various distances from the alignment using the Modelling of Train Induced Vibration (MOTIV) model and the effect of track interventions is determined as insertion loss spectra. The re-radiated noise within a typical domestic building is then estimated using generic building transfer functions. Geographic Information System tools are used to estimate the population affected by ground-borne noise and their expected level of exposure. The methodology is illustrated using a case study route between Brighton and Portsmouth in the South of England.

Feasibility of a Cost-Effectiveness Analysis Examining Interventions for Abused Persons with Intellectual Disabilities

Japan implemented new legislation to prevent the abuse of persons with disabilities on Oct 1, 2012. Many specialists from various domains participated in the development of interventions to prevent such abuse. Here, we conducted a pilot analysis to examine the cost of such interventions and to explore differences in resources. In particular, we compared resources for the assistance of victims with intellectual disabilities with those for the assistance of victims with other disabilities. We requested the enrollment of the anonymous case records of 16 local governments. Thirteen municipal/certified centres reported 41 cases, including 42 victims. Of them, 27 victims had intellectual disabilities. We calculated both the time and human/social resources consumed per case until the resolution of the case. Although the median length of time from the start of the intervention until the solution of the claimed crisis seemed longer in cases abused by their families, an analysis of 22 familial cases did not reveal a significant relationship between the type of disability and the resource. Although the existence of intellectual disabilities did not seem to impact the resource, our method of analysis worked well. The accumulation of more cases is warranted.

In newborn piglets does drying versus no intervention reduce the risk of mortality pre-weaning?

PICO question
 In newborn piglets, does drying piglets, compared to no intervention, reduce the level of mortality pre-weaning (up to 28 days)?
 Clinical bottom line
 Data specifically evaluating drying piglets are limited. Many papers had multiple factors evaluated or were assessments of management in general. There is evidence that drying piglets can reduced mortality and improve thermoregulation of piglets. The cost of such interventions has not been appraised and should be considered on a case-by-case basis. Therefore, currently when advising farmers it could be suggested that the drying of piglets may form part of a number of recommendations given to reduce piglet mortality pre-weaning.

What is the impact of rerouting a cancer diagnosis from emergency presentation to GP referral on resource use and survival? Evidence from a population-based study

BackgroundStudies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses and associated mortality risk. A dearth of evidence on the costs of such interventions might prevent new policies from achieving more ambitious targets.MethodsWe conducted a retrospective cohort study on the population of colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation and reported in the Cancer Registry of England. Resource use and survival were compared 1 year before and 5 years after diagnosis (3 years for lung), including the costs of GP referrals not converted into a positive diagnosis. Risk-adjusted statistical models were used to calculate the effect of rerouting patient’ diagnoses from emergency presentation to GP referral.ResultsRerouting a cancer diagnosis results in a relatively small additional costs to the National Health System against additional years of life saved to the patient. The cost per year of life saved is £6456 in colorectal, £1057 in breast, −£662 in prostate (savings), and £819 in lung cancer. Reducing the overall prevalence of emergency presentations to the level achieved by the 20% of Clinical Commissioning Groups with the lowest prevalence would result in £11,481,948 against 1863 years of life saved for Colorectal, £847,750 against 889 years for breast, −£943,434 (cost savings) against 1195 years for prostate, and £609,938 against 1011 years for lung cancer.ConclusionRedirecting diagnoses from emergency presentation to GP referral appears an achievable target that can produce large benefits to patients against modest additional costs to the National Health System.

Modelling potential hydrological returns from investing in ecological infrastructure: Case studies from the Baviaanskloof-Tsitsikamma and uMngeni catchments, South Africa

A shortage of water currently threatens the development of the South African economy and the well-being of its people. Climate change, land degradation and an inherently semi-arid, variable climate are making it increasingly difficult for water service providers to deliver sufficient quantity and quality of water to meet escalating demand. Investments in ecological infrastructure are seldom considered as a way of augmenting water supplies and improving water quality over the long-term. However, hydrological modelling shows that protecting and rehabilitating ecological infrastructure could generate meaningful gains in water quantity in two important South African water supply systems, the Baviaanskloof-Tsitsikamma and uMngeni catchments. The costs of such interventions, as estimated using resource economic techniques, are within the same order of magnitude as built infrastructure solutions. Investments in ecological infrastructure can also have a considerable range of other benefits. These findings make a compelling case for large-scale investment in the rehabilitation and protection of ecological infrastructure, which can be a cost-effective option for achieving water resource planning objectives. The types of rehabilitation activities planned would depend on the needs of local water users. Associated long-term monitoring and research would further improve knowledge of these systems, and provide support for the modelled results.

Development of a slender continuum robotic system for on-wing inspection/repair of gas turbine engines

The maintenance works (e.g. inspection, repair) of aero-engines while still attached on the airframes requires a desirable approach since this can significantly shorten both the time and cost of such interventions as the aerospace industry commonly operates based on the generic concept power by the hour. However, navigating and performing a multi-axis movement of an end-effector in a very constrained environment such as gas turbine engines is a challenging task. This paper reports on the development of a highly flexible slender (i.e. low diameter-to-length ratios) continuum robot of 25 degrees of freedom capable to uncoil from a drum to provide the feeding motion needed to navigate into crammed environments and then perform, with its last 6 DoF, complex trajectories with a camera equipped machining end-effector for allowing in-situ interventions at a low-pressure compressor of a gas turbine engine. This continuum robot is a compact system and presents a set of innovative mechatronics solutions such as: (i) twin commanding cables to minimise the number of actuators; (ii) twin compliant joints to enable large bending angles (ź90°) arranged on a tapered structure (start from 40mm to 13mm at its end); (iii) feeding motion provided by a rotating drum for coiling/uncoiling the continuum robot; (iv) machining end-effector equipped with vision system. To be able to achieve the in-situ maintenance tasks, a set of innovative control algorithms to enable the navigation and end-effector path generation have been developed and implemented. Finally, the continuum robot has been tested both for navigation and movement of the end-effector against a specified target within a gas turbine engine mock-up proving that: (i) max. deviations in navigation from the desired path (1000mm length with bends between 45° and 90°) are ź10mm; (ii) max. errors in positioning the end-effector against a target situated at the end of navigation path is 1mm. Thus, this paper presents a compact continuum robot that could be considered as a step forward in providing aero-engine manufacturers with a solution to perform complex tasks in an invasive manner. A novel slender continuum robot is introduced for in-situ repair/inspection of jet engines.A new kinematic model is introduced for the new tapered design.Modes of control for the continuum robot were developed, including tip-following, feeding-in/out, Machining commands.Navigation and inspection/machining tests in engine model were introduced.

Feasibility of a Cost-effectiveness Analysis Examining Interventions for Abused Persons with Mental Disabilities

Background: Japan implemented new legislation to prevent the abuse of persons with disabilities on Oct 1, 2012. Many specialists from various domains participated in the development of interventions to prevent such abuse. Here, we conducted a pilot analysis to examine the cost of such interventions and to explore differences in caseloads. In particular, we compared caseloads for the assistance of victims with mental disabilities with those for the assistance of victims with other disabilities. Methods and Findings: We requested the enrollment of the anonymous case records of 16 local governments. Thirteen municipal/certified centers reported 41 cases, including 42 victims. Of them, 12 victims had mental disabilities. We calculated both the time and human/social resources consumed per case until the resolution of the case. The median length of time from the start of the intervention until the solution of the claimed crisis was 162 days for the cases with mental disabilities, compared with 129 days for the other cases. However, an analysis of 22 familial cases did not reveal a significant relation between the type of disability and the caseload. Conclusions: Although the existence of mental disabilities did not seem to impact the caseload, our method of analysis worked well. The accumulation of more cases is warranted.

Reducing caregiver stress with internet-based interventions: a systematic review of open-label and randomized controlled trials.

The high level of stress associated with caring for others with medical conditions has been recognized for some time. Reducing caregiver stress can improve caregiver quality of life as well as improve the care they provide to loved ones. This systematic review assesses the effectiveness of internet-based interventions to decrease caregiver stress. A comprehensive literature search of Ovid MEDLINE (1946-2013), Embase (1988-2013), PsycINFO (1987-2013), and CINAHL was conducted using terms related to caregiver and internet-based interventions. Internet-based interventions involving informal caregivers in an open-label or randomized controlled trial setting were included. A pair of raters independently reviewed all published abstracts. Data regarding participants, interventions, and outcomes were extracted and, for randomized trials, methodology quality was also reviewed. Eight open-label trials met the review criteria: three showed positive benefit in reducing caregiver stress, four were partially positive (some outcomes positive, others negative), and one was a negative study. Sixteen randomized trials met the review criteria: six showed positive benefit, five were partially positive, and five were negative. There were no clear patterns as to the variables (such as study duration and complexity of intervention) associated with better outcomes, although earlier studies typically had more negative outcomes. Internet-based interventions were mostly effective in reducing aspects of caregiver stress and improving their well-being. Further studies to assess outcomes for caregivers and their recipients' health, different technology delivery methods, and the cost of such interventions are needed.

Associations between neighbourhood environmental characteristics and obesity and related behaviours among adult New Zealanders.

BackgroundThe prevalence of adult obesity is escalating in most wealthy and middle income countries. Due to the magnitude of this issue, research and interventions at the individual-level abound. However, the limited success and high costs of such interventions has led to a growing recognition of the potential role of environmental factors in reducing obesity and promoting physical activity and healthy diets.MethodsThis study utilised individual-level data from the 2006/7 New Zealand Health Survey on obesity, physical activity, diet and socio-economic variables linked to geographic information from other sources on potentially aetiologically-relevant environmental factors, based on the respondent’s residential address. We fitted logistic regression models for eight binary measures of weight or weight-related behaviours: 1) overweight; 2) obesity; 3) overweight + obesity; 4) active at least 30 minutes a day for 5+ days per week; 5) active <30 minutes per week; 6) walk 150 minutes + per week; 7) walk <30 minutes per week; and 8) consumption of 5+ fruits and vegetables per day. We included a range of independent environmental characteristics of interest in separate models.ResultsWe found that increased neighbourhood deprivation and decreased access to neighbourhood greenspace were both significantly associated with increased odds of overweight and/or obesity. The results for weight-related behaviours indicate that meeting the recommended level of physical activity per week was associated with urban/rural status, with higher activity in the more rural areas and a surprising tendency for less activity among those living in areas with higher levels of active travel to work. Increased access to greenspace was associated with high levels of walking, while decreased access to greenspace was associated with low levels of walking. There was also a significant trend for low levels of walking to be positively associated with neighbourhood deprivation. Results for adequate fruit and vegetable consumption show a significant urban/rural gradient, with more people meeting recommended levels in the more rural compared to more urban areas.ConclusionSimilar to findings from other international studies, these results highlight greenspace as an amenable environmental factor associated with obesity/overweight and also indicate the potential benefit of targeted health promotion in both urban and deprived areas in New Zealand.

Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan.

Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs.

Cost of dengue outbreaks: literature review and country case studies

BackgroundDengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks.MethodsEconomic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions.ResultsSeventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control; surveillance; information, education and communication; direct medical and indirect costs), as percentage of total costs, differed across the respective countries. Resources used for dengue disease control and treatment were country specific.ConclusionsThe evidence so far collected further confirms the methodological challenges in this field: 1) to define technically dengue outbreaks (what do we measure?) and 2) to measure accurately the costs in prospective field studies (how do we measure?). Currently, consensus on the technical definition of an outbreak is sought through the International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS). Best practice guidelines should be further developed, also to improve the quality and comparability of cost study findings. Modelling the costs of dengue outbreaks and validating these models through field studies should guide further research.

P1-126 Nutrition needs to develop effective measurement policies

Measurements of food and nutrition availability and intake inform national policy, standards and research. However, existing nutrition data are not complete and often subject to error. Accurate and comprehensive data...

The socioeconomic burden of parasitic zoonoses: Global trends

Diseases resulting from zoonotic transmission of parasites are common. Humans become infected through food, water, soil and close contact with animals. Most parasitic zoonoses are neglected diseases despite causing a considerable global burden of ill health in humans and having a substantial financial burden on livestock industries. This review aims to bring together the current data available on global burden estimates of parasitic zoonoses and indicate any changes in the trends of these diseases. There is a clear need of such information as interventions to control zoonoses are often in their animal hosts. The costs of such interventions together with animal health issues will drive the cost effectiveness of intervention strategies. What is apparent is that collectively, parasitic zoonoses probably have a similar human disease burden to any one of the big three human infectious diseases: malaria, tuberculosis or HIV in addition to animal health burden. Although the global burden for most parasitic zoonoses is not yet known, the major contributors to the global burden of parasitic zoonoses are toxoplasmosis, food borne trematode infections, cysticercosis, echinococcosis, leishmaniosis and zoonotic schistosomosis. In addition, diarrhoea resulting from zoonotic protozoa may have a significant impact.

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

BackgroundSelf-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet.ObjectiveThe objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions.MethodsIn all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis.ResultsAn overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90).ConclusionE-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well.