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

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.

Keywords: health economics; information technology; substance misuse; world wide web technology.

Conflict of interest statement

Competing interests: PW has intellectual property rights for www.downyourdrink.org.uk, is Chief Medical Advisor to the UK charity Drinkaware and has provided private consultancy on the topic of screening and brief interventions to several agencies. CL is the cofounder and Chief Executive Officer at Lumos Medica Srl, which provides software solutions for clinical trials. The other authors declare no competing interests.

© 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.

Figures

Figure 1

Consort diagram. Patient progress through trial for the primary outcome.

Figure 2

(A) Cost effectiveness acceptability plane (Italian costs only). (B) Cost-effectiveness acceptability plane (Italian and UK costs). Blue, INHS GP time only; orange, English NHS; grey, INHS training and website; yellow, INHS training only. GP, general practitioners; INHS, Italian National Health Service; NHS, National Health Service.