A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits.
A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits.
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DOI：
10.2196/jmir.5223
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发表时间：
2016-04-21
影响因子：
7.4
通讯作者：
Evers SM
中科院分区：
文献类型：
--
作者：
Drost RM;Paulus AT;Jander AF;Mercken L;de Vries H;Ruwaard D;Evers SM
防止青少年过度饮酒不仅对促进个人和公共健康很重要，而且对减少卫生保健部门内外与酒精有关的费用也很重要。电脑定制可以有效和成本效益的工作与许多生活方式的行为，但现有的信息的成本效益的电脑定制，以减少青少年饮酒是有限的，因为是有关的成本和效益的信息，卫生保健部门以外的部门，也被称为跨部门的成本和效益（ICBs）。其目的是从卫生保健的角度（不包括ICB）和社会的角度（包括ICB）评估基于网络的计算机定制干预措施的成本效益，以减少青少年的酒精使用和酗酒。使用的数据来自酒精警报研究，这是一项在学校一级随机分为两种情况的群集随机对照试验。参与者要么在基线评估（干预条件）后玩一个有针对性的酒精意识反馈的游戏，要么像往常一样接受护理（CAU），这意味着他们有机会在最终测量（等待名单控制条件）后玩游戏。在基线（T0= 2014年1月/2月）和4个月后（T1= 2014年5月/6月）记录数据，并从医疗保健角度和社会角度计算增量成本效益比（ICER）。数据中的随机不确定性通过使用非参数引导（5000次模拟重复）来处理。基于排除成本离群值进行了额外的敏感性分析。亚组成本效益分析是根据几个背景变量进行的，包括性别、年龄、教育水平、宗教和种族。从卫生保健的角度和社会的角度来看，这两个结果的措施，干预更昂贵，更有效的CAU相比。两种情况下的ICER不同，即每周每减少一杯酒和每30天减少一次狂饮，从医疗保健角度分别为40欧元和79欧元，从社会角度分别为62欧元和144欧元。亚组分析表明，从两个角度和两个结果的措施，干预是具有成本效益的年龄较大的青少年（17-19岁）和那些在较低的教育水平，从卫生保健的角度来看，男性和非宗教青少年亚组。计算机量身定制的反馈可能是针对青少年饮酒和酗酒的一种具有成本效益的方法。将国际商品机构纳入经济评价对分析的成本效益结果产生了影响。有必要针对特定的亚群体采取干预措施。Nederlands Trial Register：NTR 4048; http://www.trialregister.nl/trialreg/admin/rctview.asp? TC=4048（Webcite存档，网址：http：//www.webcitation.org/6c7omN8wG）
Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG)