Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

Rachael Hunter, Paul Wallace, Pierluigi Struzzo, Roberto Della Vedova, Francesca Scafuri, Costanza Tersar, Charilaos Lygidakis, Richard McGregor, Emanuele Scafato, Nick Freemantle

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI).

DESIGN: Randomised 1:1 non-inferiority trial.

SETTING: Practices of 58 general practitioners (GPs) in Italy.

PARTICIPANTS: Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial.

INTERVENTIONS: Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access).

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months.

RESULTS: The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI -0.007 to 0.011).

CONCLUSIONS: Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking.

TRIAL REGISTRATION NUMBER: NCT01638338;Post-results.

Original languageEnglish
Pages (from-to)e014577
JournalBMJ Open
Volume7
Issue number11
DOIs
Publication statusPublished - Nov 3 2017

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Primary Health Care
General Practitioners
Alcohols
Drinking
Costs and Cost Analysis
Pamphlets
National Health Programs
Italy
Appointments and Schedules
Outcome Assessment (Health Care)
Non-Randomized Controlled Trials

Keywords

  • Health Economics
  • Information technology
  • substance misuse
  • world wide web technology

Cite this

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website : cost-effectiveness analysis. / Hunter, Rachael; Wallace, Paul; Struzzo, Pierluigi; Vedova, Roberto Della; Scafuri, Francesca; Tersar, Costanza; Lygidakis, Charilaos; McGregor, Richard; Scafato, Emanuele; Freemantle, Nick.

In: BMJ Open, Vol. 7, No. 11, 03.11.2017, p. e014577.

Research output: Contribution to journalArticle

Hunter, R, Wallace, P, Struzzo, P, Vedova, RD, Scafuri, F, Tersar, C, Lygidakis, C, McGregor, R, Scafato, E & Freemantle, N 2017, 'Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis', BMJ Open, vol. 7, no. 11, pp. e014577. https://doi.org/10.1136/bmjopen-2016-014577
Hunter, Rachael ; Wallace, Paul ; Struzzo, Pierluigi ; Vedova, Roberto Della ; Scafuri, Francesca ; Tersar, Costanza ; Lygidakis, Charilaos ; McGregor, Richard ; Scafato, Emanuele ; Freemantle, Nick. / Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website : cost-effectiveness analysis. In: BMJ Open. 2017 ; Vol. 7, No. 11. pp. e014577.
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AU - Hunter, Rachael

AU - Wallace, Paul

AU - Struzzo, Pierluigi

AU - Vedova, Roberto Della

AU - Scafuri, Francesca

AU - Tersar, Costanza

AU - Lygidakis, Charilaos

AU - McGregor, Richard

AU - Scafato, Emanuele

AU - Freemantle, Nick

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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N2 - OBJECTIVES: To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI).DESIGN: Randomised 1:1 non-inferiority trial.SETTING: Practices of 58 general practitioners (GPs) in Italy.PARTICIPANTS: Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial.INTERVENTIONS: Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access).PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months.RESULTS: The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI -0.007 to 0.011).CONCLUSIONS: Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking.TRIAL REGISTRATION NUMBER: NCT01638338;Post-results.

AB - OBJECTIVES: To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI).DESIGN: Randomised 1:1 non-inferiority trial.SETTING: Practices of 58 general practitioners (GPs) in Italy.PARTICIPANTS: Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial.INTERVENTIONS: Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access).PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months.RESULTS: The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI -0.007 to 0.011).CONCLUSIONS: Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking.TRIAL REGISTRATION NUMBER: NCT01638338;Post-results.

KW - Health Economics

KW - Information technology

KW - substance misuse

KW - world wide web technology

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DO - 10.1136/bmjopen-2016-014577

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JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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