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Table 1 Three intervention models from the Sheffield Alcohol Policy Model, version 2

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

 
  1. GP = general practice; ED = emergency department; BI = brief intervention; AUDIT = Alcohol Use Disorders Identification Test (AUDIT-C = three AUDIT consumption questions); DES = direct enhanced service; PAT = Paddington Alcohol Test; FAST = Fast Alcohol Screening Test; ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life year.