From: Can screening and brief intervention lead to population-level reductions in alcohol-related harm?
Next GP Registration | Next GP Consultation | Next ED Consultation | |
---|---|---|---|
Baseline Scenarios | Practice nurse undertakes both screening and, where appropriate, BI | Physician undertakes both screening and, where indicated, BI as part of consultation | Prescreen applied depending on reason for attendance or diagnosis, screening prior to discharge, BI offered as a separate appointment on day after screening |
► Screening using full AUDIT followed by 25-minute intervention | ► Screening using full AUDIT followed by 25-minute intervention | ► Assume 30% take-up of BI, prescreen similar to PAT, screening with FAST, followed by 50-minute intervention | |
► Screening using AUDIT-C followed by 5-minute intervention (similar to DES configuration) | ► Screening using AUDIT-C followed by 5-minute intervention (similar to DES configuration) | ||
► Screening using FAST followed by 5-minute intervention | ► Screening using FAST followed by 5-minute intervention | ||
Results | In all three cases, estimated costs of delivering BI outweighed by financial savings due to subsequent reduced burden of illness | For 25-minute BI, estimated costs outweigh health-care costs avoided, with net cost overall and ICER of £5,900 per QALY gained (i.e., cost-effective) | ICER estimated at £9,700 per QALY (i.e., cost-effective) |
QALY gains and, therefore, baseline interventions estimated to be better than “doing nothing” | For 5-minute BI, intervention costs lower and ICER improved, i.e., cost-savings | Despite 10-year program involving screening over three-fourths of adult population, only 18% of hazardous/harmful drinkers estimated to receive BI due to low take-up rate of 30% | |
Screening on next registration estimated to apply to 39% of population of England over 10-year period, with one-third of hazardous and harmful drinkers being screened, detected, and given BI | Different from next GP registration because | ||
► GP staff costs higher than those of practice nurse | |||
► Men consult less frequently than women | |||
► Patients consult GP much more frequently than they change GP | |||
Thus, 96% of population screened over 10 years (the majority in the first year) with 70-79% hazardous/harmful drinkers receiving BI | |||
Estimated gain is over 100,000 QALYs over 10-year screening program |