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Advice from primary care staff to reduce ‘heavy’ drinking to ‘moderate’ drinking may be cost-effective
EV ID E N C E- B A S E D H E AL T H P RO M O T I O N
Advice from primary care staff to reduce ‘heavy’ drinking to ‘moderate’ drinking may be cost-effective Abstracted from: Lindholm L. Alcohol advice in primary health care d is it a wise use of resources? Health Policy 1998;45:47d56
E
OBJECTIVE To calculate the cost-effectiveness of advice aimed at reducing ‘heavy’ drinking to ‘moderate’ drinking. SETTING Primary care. METHOD Cost-effectiveness analysis. LITERATURE REVIEW No explicit strategy; 30 references. Existing evidence on effectiveness and epidemiology is used in the analysis. No details are provided on how this data was identified or what criteria were used to select the studies on which greatest reliance is placed. INTERVENTION Screening for alcohol-related problems and GP or nurse visits. OUTCOMES Cost in ECUs per life-year saved. No account is taken of impact in terms of quality of life or increased productivity. ANALYSIS Cost-effectiveness estimates are calculated for a range of alternative combinations of E Number of visits (5 per year or 25 per year). E Whether visits are conducted by nurses or GPs. E Whether the relative risk of death in ‘heavy’ vs ‘moderate’ drinkers is 2.0, 1.5 or 1.25. E Whether the proportion who show a sustained reduction in drinking from ‘heavy’ to ‘moderate’ is 2, 10 or 20%
Commentary The adverse health effects of excessive alcohol consumption are well established, though it is now clear that moderate alcohol intake confers benefits. There are therefore strong health arguments for moderation of alcohol consumption. As with other health-related lifestyle behaviours two approaches to this are recognized d mass, public policy/public health initiatives and individual interventions, particularly opportunistic brief advice from primary care doctors and nurses. As the article indicates, there is substantial controlled trial evidence that such advice to patients with excessive alcohol consumption can have a modest effect in reducing this. Using findings from epidemiological studies of the relationship between alcohol intake and morbidity and taking the results of the intervention trials, costdbenefit analysis can be undertaken of the cost-effectiveness of these interventions d and this article does this. The results of this analysis suggest that effectiveness as low as 1% for brief advice by primary care doctors and nurses is worthwhile.
^ 1999 Harcourt Publishers Ltd
Whether health benefits as well as costs are discounted at 5% per annum
RESULTS For a five-visit, family doctor-led intervention the estimated cost per LYS, where costs and benefits are discounted, varied as indicated ((0 indicates benefits were obtained with decreased cost): Proportion changing from ‘heavy’ to ‘moderate’ drinking (%) 20 10 2
RR of death of ‘heavy’ vs ‘moderate’ drinking 2 (0 (0 10 000
1.5 (0 (0 20 000
1.25 (0 (0 40 000
Costs where a nurse undertook the intervention were about 50% of the above. AUTHOR’S CONCLUSIONS Alcohol advice from primary care staff has the potential to be a cost-effective intervention.
Over the last couple of decades there has been emphasis on the role of primary care in influencing lifestyle behaviours d particularly smoking, drinking and eating. Trials have consistently demonstrated that brief interventions do have sustained effects and that such interventions are cost-effective. But the demand-led nature of health care and shortage of time in primary care consultations limit the extent to which lifestyle advice can be and is delivered. So a wide gap between potential and achievement is likely to remain. Professor Godfrey Fowler Emeritus Professor of General Practice, Institute of Health Sciences, University of Oxford, UK
Evidence-based Healthcare (1999) 3, 83
83
Advice from primary care staff to reduce ‘heavy’ drinking to ‘moderate’ drinking may be cost-effective Abstracted from: Lindholm L. Alcohol advice in primary health care d is it a wise use of resources? Health Policy 1998;45:47d56
E
OBJECTIVE To calculate the cost-effectiveness of advice aimed at reducing ‘heavy’ drinking to ‘moderate’ drinking. SETTING Primary care. METHOD Cost-effectiveness analysis. LITERATURE REVIEW No explicit strategy; 30 references. Existing evidence on effectiveness and epidemiology is used in the analysis. No details are provided on how this data was identified or what criteria were used to select the studies on which greatest reliance is placed. INTERVENTION Screening for alcohol-related problems and GP or nurse visits. OUTCOMES Cost in ECUs per life-year saved. No account is taken of impact in terms of quality of life or increased productivity. ANALYSIS Cost-effectiveness estimates are calculated for a range of alternative combinations of E Number of visits (5 per year or 25 per year). E Whether visits are conducted by nurses or GPs. E Whether the relative risk of death in ‘heavy’ vs ‘moderate’ drinkers is 2.0, 1.5 or 1.25. E Whether the proportion who show a sustained reduction in drinking from ‘heavy’ to ‘moderate’ is 2, 10 or 20%
Commentary The adverse health effects of excessive alcohol consumption are well established, though it is now clear that moderate alcohol intake confers benefits. There are therefore strong health arguments for moderation of alcohol consumption. As with other health-related lifestyle behaviours two approaches to this are recognized d mass, public policy/public health initiatives and individual interventions, particularly opportunistic brief advice from primary care doctors and nurses. As the article indicates, there is substantial controlled trial evidence that such advice to patients with excessive alcohol consumption can have a modest effect in reducing this. Using findings from epidemiological studies of the relationship between alcohol intake and morbidity and taking the results of the intervention trials, costdbenefit analysis can be undertaken of the cost-effectiveness of these interventions d and this article does this. The results of this analysis suggest that effectiveness as low as 1% for brief advice by primary care doctors and nurses is worthwhile.
^ 1999 Harcourt Publishers Ltd
Whether health benefits as well as costs are discounted at 5% per annum
RESULTS For a five-visit, family doctor-led intervention the estimated cost per LYS, where costs and benefits are discounted, varied as indicated ((0 indicates benefits were obtained with decreased cost): Proportion changing from ‘heavy’ to ‘moderate’ drinking (%) 20 10 2
RR of death of ‘heavy’ vs ‘moderate’ drinking 2 (0 (0 10 000
1.5 (0 (0 20 000
1.25 (0 (0 40 000
Costs where a nurse undertook the intervention were about 50% of the above. AUTHOR’S CONCLUSIONS Alcohol advice from primary care staff has the potential to be a cost-effective intervention.
Over the last couple of decades there has been emphasis on the role of primary care in influencing lifestyle behaviours d particularly smoking, drinking and eating. Trials have consistently demonstrated that brief interventions do have sustained effects and that such interventions are cost-effective. But the demand-led nature of health care and shortage of time in primary care consultations limit the extent to which lifestyle advice can be and is delivered. So a wide gap between potential and achievement is likely to remain. Professor Godfrey Fowler Emeritus Professor of General Practice, Institute of Health Sciences, University of Oxford, UK
Evidence-based Healthcare (1999) 3, 83
83