Review and special articlePrimary Care Intervention to Reduce Alcohol Misuse: Ranking Its Health Impact and Cost Effectiveness
Section snippets
Methods
The ability to compare different preventive services depends on applying the same methods to each service, which was done by utilizing the methods described previously.6 This article’s methods adhere to the approach used with other services, but the description here is focused on the issues and details that are unique to this topic. Additional details of the models not presented here are available online.7
The approach used here was to estimate the health impact and cost effectiveness of regular
Results of Literature Review and Model Specification
The data points used in the model are shown in Table 1, along with their sources and the ranges over which each variable was explored in sensitivity analysis. All analyses were completed in 2006.
Results of Model: CPB and Cost Effectiveness Estimates
Results of calculations before discounting are shown in Table 2. The predicted gain per person in the target population is 0.045 QALYs, or 0.052 QALYs saved per person who completes screening. To rank this service, CPB was estimated as the total, undiscounted QALYs saved in a birth cohort of 4,000,000, factoring in patient non-adherence: 176,000 QALYs saved.
Without discounting, the lifetime costs of the service are divided nearly equally among clinician and patient time costs of screening and
Discussion
Although wide variation in costs per QALY are produced by changes in the assumptions about effectiveness and the cost-effectiveness variables noted above, the mean of those ranges still results in a CPB score of 4 and cost-effectiveness score of 5 (on a 1–5 geometric scale).2 Among the 25 services studied, all given positive recommendations by the USPSTF, alcohol misuse achieved a combined score of 9, similar to screening for colorectal cancer, hypertension, or vision (adults over 64), and to
References (127)
- et al.
Priorities among recommended clinical preventive services
Am J Prev Med
(2001) - et al.
Priorities among effective clinical preventive services results of a systematic review and analysis
Am J Prev Med
(2006) - et al.
Current methods of the U.S. Preventive Services Task Force: a review of the process
Am J Prev Med
(2001) - et al.
Priorities among effective clinical preventive services methods
Am J Prev Med
(2006) Alcohol advice in primary health care--is it a wise use of resources?
Health Policy
(1998)- et al.
Project ASSERT: an ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system
Ann Emerg Med
(1997) - et al.
The effect among older persons of a general preventive visit on three health behaviors: smoking, excessive alcohol drinking, and sedentary lifestyle
Prev Med
(1995) - et al.
Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial
Lancet
(2004) - et al.
Using self-help materials to motivate change at assessment for alcohol treatment
J Subst Abuse Treat
(2001) - et al.
Naltrexone and brief counseling to reduce heavy drinking in hazardous drinkers
Addict Behav
(2004)
Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial
Patient Educ Couns
Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers
Addict Behav
Examining mechanisms of action in 12-Step community outpatient treatment
Drug Alcohol Depend
The Tromso Study: identification of and a controlled intervention on a population of early-stage risk drinkers
Prev Med
Early intervention in patients with excessive consumption of alcohol: a controlled study
Alcohol
Brief intervention in a primary care setting for hazardous drinkers
Am J Prev Med
Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force
Ann Intern Med
Primary care: is there enough time for prevention?
Am J Public Health
Alcohol misuse screening and behavioral counseling: technical report prepared for the National Commission on Prevention Priorities
Methods for prioritizing clinical preventive servicesTechnical report prepared for the National Commission on Prevention Priorities
Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings
Med Care
Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis
Alcohol Clin Exp Res
Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department
J Stud Alcohol
The costs of screening and brief intervention for risky alcohol use
J Stud Alcohol
Cost-effectiveness in health and medicine
Brief intervention for female heavy drinkers in routine general practice: a 3-year randomized, controlled study
Alcohol Clin Exp Res
Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study
Alcohol Alcohol
The effect of general practitioners’ advice to heavy drinking men
Br J Addict
Implementation and dissemination of methods for prevention of alcohol problems in primary health care: a feasibility study
Alcohol Alcohol
Intervention of heavy drinking: a prospective and controlled study of 438 consecutive injured male patients
Alcohol Alcohol
Brief intervention for heavy-drinking college students: 4-year follow-up and natural history
Am J Public Health
Identification and brief treatment of alcohol problems with medical patients: an international perspective
Alcohol Clin Exp Res
Brief alcohol interventions with mandated or adjudicated college students
Alcohol Clin Exp Res
Older patients with at-risk and problem drinking patterns: new developments in brief interventions
J Geriatr Psychiatry Neurol
Effects of a brief motivational intervention with college student drinkers
J Consult Clin Psychol
Alcohol-related discussions during general medicine appointments of male VA patients who screen positive for at-risk drinking
J Gen Intern Med
The efficacy of the social norms approach to substance abuse prevention applied to fraternity men
J Am Coll Health
Establishing treatment relations with alcoholics
J Nerv Ment Dis
An evaluation of three treatment programmes for alcoholism: an experimental study with 6- and 8-month follow-ups
Br J Addict
Effectiveness of brief intervention on nondependent alcohol drinkers (EBIAL): a Spanish multi-centre study
Fam Pract
A randomized trial of a brief primary-care-based intervention for reducing at-risk drinking practices
Health Psychol
Assessing alcohol consumption in general practice patients--a comparison between questionnaire and interview (findings of the Medical Research Council’s general practice research framework study on lifestyle and health)
Alcohol Alcohol
Interventions for preventing injuries in problem drinkers
Cochrane Database Syst Rev
Attempted referral as intervention for problem drinking in the general hospital
Br J Addict
Brief physician advice for problem alcohol drinkers: a randomized controlled trial in community-based primary care practices
JAMA
Brief physician advice for alcohol problems in older adults: a randomized community-based trial
J Fam Pract
Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization
J Behav Health Serv Res
Medical specialization, profession, and mediating beliefs that predict stated likelihood of alcohol screening and brief intervention: targeting educational interventions
Subst Abus
Outcome of trauma patients after brief intervention by a substance abuse consultation service
Am J Addict
Alcohol abuse in women seeking gynecologic care
Obstet Gynecol
Cited by (237)
Screening for Unhealthy Alcohol and Drug Use in General Medicine Settings
2022, Medical Clinics of North AmericaDevelopment and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure
2022, Journal of the American Pharmacists AssociationRacial/ethnic and gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the U.S. Veterans Health Administration
2020, Journal of Substance Abuse TreatmentDevelopment of community strategies supporting brief alcohol advice in three Latin American countries: a protocol
2023, Health Promotion International
The full text of this article is available via AJPM Online at www.ajpm-online.net; 1 unit of Category-1 CME credit is also available, with details on the website.