1
|
Ulfsdotter Gunnarsson K, Henriksson M, Bendtsen M. Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes. J Med Internet Res 2024; 26:e44574. [PMID: 38536228 PMCID: PMC11007605 DOI: 10.2196/44574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/19/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Alcohol consumption causes both physical and psychological harm and is a leading risk factor for noncommunicable diseases. Digital alcohol interventions have been found to support those looking for help by giving them tools for change. However, whether digital interventions can help tackle the long-term societal consequences of harmful alcohol consumption in a cost-effective manner has not been adequately evaluated. In this Viewpoint, we propose that studies of digital alcohol interventions rarely evaluate the consequences of wider dissemination of the intervention under study, and that when they do, they do not take advantage of modeling techniques that allow for appropriately studying consequences over a longer time horizon than the study period when the intervention is tested. We argue that to help decision-makers to prioritize resources for research and dissemination, it is important to model long-term costs and health outcomes. Further, this type of modeling gives important insights into the context in which interventions are studied and highlights where more research is required and where sufficient evidence is available. The viewpoint therefore invites the researcher not only to reflect on which interventions to study but also how to evaluate their long-term consequences.
Collapse
Affiliation(s)
| | - Martin Henriksson
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
Collapse
Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| |
Collapse
|
3
|
Gueta K, Harel-Fisch Y, Walsh SD. Cultural accommodation of internet-based interventions for substance use and related disorders: a proposed comprehensive framework based on a pilot study and a literature review. Front Psychol 2023; 14:1063200. [PMID: 37416542 PMCID: PMC10321598 DOI: 10.3389/fpsyg.2023.1063200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.
Collapse
Affiliation(s)
- Keren Gueta
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Yossi Harel-Fisch
- The International Research Program on Adolescent Well-Being and Health, School of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Sophie D. Walsh
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
4
|
Buntrock C, Freund J, Smit F, Riper H, Lehr D, Boß L, Berking M, Ebert DD. Reducing problematic alcohol use in employees: economic evaluation of guided and unguided web-based interventions alongside a three-arm randomized controlled trial. Addiction 2022; 117:611-622. [PMID: 34648235 DOI: 10.1111/add.15718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
AIMS To perform an economic evaluation of guided and unguided internet-based interventions to reduce problematic alcohol consumption in employees compared with a waiting-list control condition (WLC) with unrestricted access to treatment-as-usual. DESIGN A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal and a cost-benefit analysis from the employer's perspective with a 6-month time horizon. SETTING Open recruitment in the German working population. PARTICIPANTS Employees (178 males, 256 females, mean age 47 years) consuming at least 14 (women) or 21 (men) standard units of alcohol (SUAs) per week and scoring ≥ 8 (men) or 6 (women) on the Alcohol Use Disorders Identification Test. MEASUREMENTS On-line questionnaires administered to assess SUAs and assess quality of life (AQoL-8D) and resource use. Outcome measure was responder (≤ 14/≤ 21 SUAs) for the CEA and quality-adjusted life years (QALYs) for the CUA. Net benefit regression was used to estimate cost-effectiveness for each study arm. Bootstrapping and sensitivity analyses were performed to account for uncertainty. INTERVENTIONS Five weekly modules including personalized normative feedback, motivational interviewing, goal setting, problem-solving and emotion regulation, provided with adherence-focused guidance [n = 142; responders: n = 73 (51.4%); QALYs = 0.364, standard error (SE) = 0.006] or without guidance [n = 146; n = 66 (45.2%); 0.359, 0.007]. Controls were on a waiting-list [n = 144; n = 38 (26.4%); 0.342, 0.007]. FINDINGS From a societal perspective, the guided intervention had a probability of 55% (54%) of being the most efficient strategy at a willingness-to-pay (WTP) of €0 per responder (QALY) gained, compared with the unguided intervention and the control condition. At a WTP of €20 000 per QALY gained, the probability was 78%. From an employer's perspective, the guided intervention had a higher probability of a positive return on investment (81%) compared with the unguided intervention (58%). CONCLUSION A guided internet-based intervention to reduce problematic alcohol consumption in employees appears to be both cost-beneficial and cost-effective.
Collapse
Affiliation(s)
- Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy. Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Johanna Freund
- Department of Clinical Psychology and Psychotherapy. Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Filip Smit
- Trimbos Institute (Netherland Institute of Mental Health and Addiction), Utrecht, the Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands.,Telepsychiatric Centre, University of Southern Denmark, Odense, Denmark
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Leif Boß
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy. Institute of Psychology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| |
Collapse
|
5
|
Schaub MP, Tiburcio M, Martínez-Vélez N, Ambekar A, Bhad R, Wenger A, Baumgartner C, Padruchny D, Osipchik S, Poznyak V, Rekve D, Landi Moraes F, Monezi Andrade AL, Oliveira Souza-Formigoni ML. The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial. J Med Internet Res 2021; 23:e21686. [PMID: 34448710 PMCID: PMC8433861 DOI: 10.2196/21686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/17/2020] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program "Alcohol e-Health." OBJECTIVE We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial. METHODS This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8). RESULTS For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=-4.18, 95% CI -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results. CONCLUSIONS The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results. TRIAL REGISTRATION ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1111/add.14034.
Collapse
Affiliation(s)
- Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Nora Martínez-Vélez
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Dzianis Padruchny
- Republican Research and Practice Center for Mental Health, Minsk, Belarus
| | - Sergey Osipchik
- Republican Research and Practice Center for Mental Health, Minsk, Belarus
| | - Vladimir Poznyak
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Dag Rekve
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Fabricio Landi Moraes
- Departamento de Psicobiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - André Luiz Monezi Andrade
- Centre for Life Sciences, Department of Psychology, Pontifica Universidade Católica de Campinas, Campinas, Brazil
| | | |
Collapse
|
6
|
Buntrock C, Kählke F, Smit F, Ebert DD. A systematic review of trial-based economic evaluations of internet- and mobile-based interventions for substance use disorders. Eur J Public Health 2021; 31:i19-i28. [PMID: 31298687 PMCID: PMC8266535 DOI: 10.1093/eurpub/ckz022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) contribute significantly to global rates of morbidity and mortality. Internet- and mobile-based interventions (IMIs) have been suggested as an adjunct to face-to-face health services. However, the evidence for the cost-effectiveness of IMIs for SUDs is scant. METHODS A comprehensive literature search in PubMed, PsycINFO, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database and EconLit was conducted. We included economic evaluations alongside randomized controlled trials of IMIs for SUDs compared with a control group. RESULTS Of 1687 abstracts identified, 11 studies met the inclusion criteria. Targeted conditions were alcohol use disorder (four studies) and tobacco smoking (five studies) whereas two studies included any SUD. Cost-effectiveness results demonstrated that IMIs had a firm probability of being more cost-effective than TAU (e.g. less costs per additional abstinent person). Compared with (online) psycho-education, evidence towards an additional benefit of IMIs was less clear. Regarding cost-utility (e.g. costs per quality-adjusted life year gained), except for one study, results suggested that TAU and online psycho-education would probably be more preferable than IMIs. Quality of study reporting was at least adequate. CONCLUSIONS The likelihood of IMIs being more cost-effective than TAU looks promising but more economic evaluations are needed in order to determine the economic merit of IMIs. With an increasing pressure on health care budgets, strategies to disseminate effective interventions at affordable costs are required. This review suggests that IMIs might carry that promise and have potential as a cost-effective strategy to scale-up existing evidence-based treatments for SUDs. SYSTEMATIC REVIEW REGISTRATION The systematic review has been registered in the PROSPERO database (no. CRD42018099486).
Collapse
Affiliation(s)
- Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Fanny Kählke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Filip Smit
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Barbosa C, Bray JW, Dowd WN, Barnosky A, Wittenberg E. SF-6D utility scores for alcohol use disorder status and alcohol consumption risk levels in the US population. Addiction 2021; 116:1034-1042. [PMID: 33448504 PMCID: PMC7882636 DOI: 10.1111/add.15224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/26/2020] [Accepted: 08/07/2020] [Indexed: 01/12/2023]
Abstract
AIMS To estimate US population health utilities for subgroups defined by alcohol use disorder (AUD) status and consumption level. DESIGN Cross-sectional survey. SETTING Community settings in the United States (i.e. excluding institutional settings). PARTICIPANTS A total of 36,042 adults (age 18+) in non-institutional settings in the United States. MEASUREMENTS We used 12-item Short Form Survey (SF-12) data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to calculate mean Short Form-6 dimension (SF-6D) utility scores across World Health Organization alcohol consumption risk levels-very high risk, high risk, medium risk, low risk and an additional abstinent level-for three groups: (1) the general population (n = 36,042), (2) individuals with life-time AUD (n = 9925) and (3) individuals with current AUD (n = 5083), and assessed minimally important differences (MIDs) between consumption levels. Each group is a subset of the previous group. FINDINGS The general population's mean SF-6D utility was higher than that of individuals with life-time or current AUD across all consumption risk levels (0.79 versus 0.76 for both AUD groups). For all groups, SF-6D utilities increased as consumption risk level decreased to non-abstinent levels, and reducing consumption from very high risk to any lower level was associated with a statistically significant and meaningful improvement in utility. For individuals with life-time or current AUD, becoming abstinent from high-, medium- and low-risk levels was associated with significantly and meaningfully worse utilities. CONCLUSIONS Higher alcohol consumption risk levels appear to be associated with lower health index scores for the general population and individuals with a history of alcohol use disorder, meaning that higher alcohol consumption is associated with worse health-related quality of life.
Collapse
Affiliation(s)
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina, Greensboro, NC, USA
| | | | | | - Eve Wittenberg
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Moriarty KJ. Alcohol care teams: where are we now? Frontline Gastroenterol 2019; 11:293-302. [PMID: 32582422 PMCID: PMC7307041 DOI: 10.1136/flgastro-2019-101241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 02/06/2023] Open
Abstract
Alcohol consumption affects the risks of approximately 230 three-digit disease and injury codes in the International Statistical Classification of Diseases and Related Health Problems-10th Revision. The United Nations Sustainable Development Goals comprise 17 challenging goals with 169 targets, which the 193 Member States aim to achieve by 2030. Action to reduce the harmful use of alcohol, especially addressing global health inequalities, will contribute to achieving many of the health-related goals and targets. Alcohol care teams, mainly developed in acute UK hospitals, reduce acute hospital admissions, readmissions and mortality, improve the quality and efficiency of alcohol care, and have 11 key evidence-based, cost-effective and aspirational components. A clinician-led, multidisciplinary team, with integrated alcohol treatment pathways across primary, secondary and community care, coordinated alcohol policies for emergency departments and acute medical units, a 7-day alcohol specialist nurse service, addiction and liaison psychiatry services, an alcohol assertive outreach team, and consultant hepatologists and gastroenterologists with liver disease expertise facilitate collaborative, multidisciplinary, person-centred care. Quality metrics, national indicators, audit, workforce planning, training and accreditation support research and education of the public and healthcare professionals. Hospitals should collaborate with local authorities, public health, clinical commissioning groups, patients and key stakeholders to develop and disseminate cost-effective prevention and treatment strategies. Globally, alcohol care teams can support the achievement of the United Nations Sustainable Development Goals, and should be advocated and implemented through the WHO global alcohol strategy. This requires collaborative care planning by key stakeholders, a skilled workforce, targeted financial resources and dedicated political commitment.
Collapse
|
9
|
Kählke F, Buntrock C, Smit F, Berking M, Lehr D, Heber E, Funk B, Riper H, Ebert DD. Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial. JMIR Ment Health 2019; 6:e10866. [PMID: 31094355 PMCID: PMC6707573 DOI: 10.2196/10866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 11/02/2018] [Accepted: 12/30/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. TRIAL REGISTRATION German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/1471-2458-13-655.
Collapse
Affiliation(s)
- Fanny Kählke
- Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Buntrock
- Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Filip Smit
- Amsterdam Public Health, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands.,Netherlands Institute of Public Mental Health, Centre of Health-Economic Evaluation, Trimbos Institute, Utrecht, Netherlands
| | - Matthias Berking
- Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Lehr
- Institute for Psychology, Department of Health Psychology and Applied Biological Psychology, Leuphana University, Lüneburg, Germany
| | - Elena Heber
- GET.ON Institute for Online Health Trainings, Hamburg, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - Heleen Riper
- Amsterdam Public Health, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Telepsychiatric Centre, University of Southern Denmark, Odense, Denmark
| | - David Daniel Ebert
- Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Amsterdam Public Health, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| |
Collapse
|
10
|
Hswen Y, Qin Q, Brownstein JS, Hawkins JB. Feasibility of using social media to monitor outdoor air pollution in London, England. Prev Med 2019; 121:86-93. [PMID: 30742873 PMCID: PMC7316422 DOI: 10.1016/j.ypmed.2019.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/24/2018] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
Air pollution is a serious public health concern. Innovative and scalable methods for detecting harmful air pollutants such as PM2.5 are necessary. This study assessed the feasibility of using social media to monitor outdoor air pollution in an urban area by comparing data from Twitter and validating it against established air monitoring stations. Data were collected from London, England from July 29, 2016 to March 17, 2017. Daily mean PM2.5 data was downloaded from the LondonAir platform consisting of 26 air pollution monitoring sites throughout Greater London. Publicly available tweets geo-located to Greater London containing air pollution terms were captured from the Twitter platform. Tweets with media URL links were excluded to minimize influence of news stories. Sentiment of the tweets was examined as negative, positive, or neutral. Cross-correlation analyses were used to compare the relationship between trends of tweets about air pollution and levels of PM2.5 over time. There were 16,448 tweets without a media URL link, with a mean of 498.42 (SD = 491.08) tweets per week. A significant cross-correlation coefficient of 0.803 was observed between PM2.5 data and the non-media air pollution tweets (p < 0.001). The cross-correlation coefficient was highest between PM2.5 data and air pollution tweets with negative sentiment at 0.816 (p < 0.001). Discussions about air pollution on Twitter reflect particle PM2.5 pollution levels in Greater London. This study highlights that social media may offer a supplemental source to support the detection and monitoring of air pollution in a densely populated urban area.
Collapse
Affiliation(s)
- Yulin Hswen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Informatics Program, Boston Children's Hospital, Boston, MA, USA.
| | - Qiuyuan Qin
- Informatics Program, Boston Children's Hospital, Boston, MA, USA; Department of Statistics, Boston University, Boston, MA, USA
| | - John S Brownstein
- Informatics Program, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jared B Hawkins
- Informatics Program, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Arnaud N, Thomasius R. [Prevention of substance use disorders]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 48:381-392. [PMID: 30453823 DOI: 10.1024/1422-4917/a000636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Prevention of substance use disorders Abstract. Introduction: Adolescence is a vulnerable period for the development of Substance Use Disorders and preventive intervention is a public health priority. In this article, we summarize the available evidence for behavioral preventive action for Substance Use Disorders and related dysregulated behaviors during adolescence in various settings. Results: Current meta-analytic evidence is available mainly for the school and family settings and increasingly also for internet-based prevention. The literature is dominated by US-studies that focus on universal school-based approaches for legal substances in middle adolescence. Only few German studies are published. Taken together the results indicate that developmentally sensitive substance use prevention is effective across different settings with consistent small-to-middle sized effects. Differential effectiveness analyses for schoolbased prevention suggest that younger adolescents benefit most from universal prevention, while for older adolescents targeted approaches are more effective. Conclusions: Across the relevant settings, effective preventive measures are available. However, the results could be improved. There is a need for translational research on effective and more individualized approaches to prevention and differential effects of intervention modules. Moreover, there is a need for research on the implementation of evidence-based programs and especially in Germany, coordinated approaches on community levels are lacking.
Collapse
Affiliation(s)
- Nicolas Arnaud
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
12
|
Watkins LE, Sprang K. An Overview of Internet- and Smartphone-Delivered Interventions for Alcohol and Substance Use Disorders. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:376-383. [PMID: 31975929 DOI: 10.1176/appi.focus.20180016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Substance use disorders are a serious public health concern that affect approximately one in 12 individuals 12 years and older. Despite the high need for effective treatments for substance use disorders, the underutilization of services is well documented. One potential method of increasing access to care is through the use of technology. Treatment through the Internet or smartphone provides attractive solutions for those who are ambivalent to seeking treatment, because these treatments are easy to access from almost anywhere, self-paced, low commitment, and anonymous. The purpose of this review is to summarize the literature on Internet and smartphone interventions for substance use disorders that were developed on the basis of evidence-based treatments. The authors discuss these interventions within two broad categories: brief motivational or feedback-oriented interventions, which typically include one or two sessions, and longer interventions, which include multiple modules and are based on cognitive-behavior therapy, relapse prevention, contingency management, or a community reinforcement approach. These therapeutic adaptations through new technologies allow for increased access to substance use treatments and appear to yield overall positive results in adjusting norms about substance use, decreasing and ceasing substance use, and improving confidence to manage substance use.
Collapse
Affiliation(s)
- Laura E Watkins
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| | - Kelsey Sprang
- Dr. Watkins and Dr. Sprang are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| |
Collapse
|
13
|
Angus C, Li J, Romero-Rodriguez E, Anderson P, Parrott S, Brennan A. Cost-effectiveness of strategies to improve delivery of brief interventions for heavy drinking in primary care: results from the ODHIN trial. Eur J Public Health 2018; 29:219-225. [DOI: 10.1093/eurpub/cky181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Esperanza Romero-Rodriguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
14
|
Sundström C, Blankers M, Khadjesari Z. Computer-Based Interventions for Problematic Alcohol Use: a Review of Systematic Reviews. Int J Behav Med 2018; 24:646-658. [PMID: 27757844 PMCID: PMC5608865 DOI: 10.1007/s12529-016-9601-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose The aim of this review is to provide an overview of knowledge and knowledge gaps in the field of computer-based alcohol interventions by (1) collating evidence on the effectiveness of computer-based alcohol interventions in different populations and (2) exploring the impact of four specified moderators of effectiveness: therapeutic orientation, length of intervention, guidance and trial engagement. Methods A review of systematic reviews of randomized trials reporting on effectiveness of computer-based alcohol interventions published between 2005 and 2015. Results Fourteen reviews met the inclusion criteria. Across the included reviews, it was generally reported that computer-based alcohol interventions were effective in reducing alcohol consumption, with mostly small effect sizes. There were indications that longer, multisession interventions are more effective than shorter or single session interventions. Evidence on the association between therapeutic orientation of an intervention, guidance or trial engagement and reductions in alcohol consumption is limited, as the number of reviews addressing these themes is low. None of the included reviews addressed the association between therapeutic orientation, length of intervention or guidance and trial engagement. Conclusions This review of systematic reviews highlights the mostly positive evidence supporting computer-based alcohol interventions as well as reveals a number of knowledge gaps that could guide future research in this field.
Collapse
Affiliation(s)
| | - Matthijs Blankers
- Trimbos institute-the Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Arkin Mental Health Care, Amsterdam, The Netherlands.,Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Zarnie Khadjesari
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| |
Collapse
|
15
|
Olmos A, Tirado-Muñoz J, Farré M, Torrens M. The efficacy of computerized interventions to reduce cannabis use: A systematic review and meta-analysis. Addict Behav 2018; 79:52-60. [PMID: 29248863 DOI: 10.1016/j.addbeh.2017.11.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Cannabis is the most widely consumed illicit drug. Although it is too early to confirm the impact of legalization, the use of cannabis appears to be on the rise in some countries due to its authorization for medical/recreational purposes. Among different types of therapeutic approaches to reduce cannabis use, computerized interventions are becoming a new treatment option. To assess their efficacy, a systematic review and meta-analysis was conducted. METHODS A systematic review and meta-analysis was performed employing randomized controlled clinical trials indexed in MEDLINE and PsycINFO. The principal outcome measure was cannabis use, and the secondary one was the use of other substances during interventions. A subgroup analysis was conducted by length of follow-up, number of sessions, age group, type of analysis, and type of control condition. RESULTS The meta-analysis included nine studies with 2963 participants. Computerized interventions resulted in significant reductions in the use of cannabis (standardized mean difference [SMD]: -0.19; 95% CI: -0.26, -0.11) and other substances (SMD: -0.27; 95% CI: -0.46, -0.08). CONCLUSIONS Computerized interventions examined in the present study reduced the frequency of cannabis and other substance use. Limitations included the recalculation of dichotomous and continuous data as SMD and the lower number of studies included in the secondary outcome. Computerized interventions could be a viable option to reduce cannabis use.
Collapse
Affiliation(s)
- Alexandre Olmos
- Universitat Pompeu Fabra-Universitat Autònoma de Barcelona, Barcelona 08003, Spain
| | - Judit Tirado-Muñoz
- Addiction Research Group, IMIM-Institut Hospital del Mar d' Investigacions Mèdiques, Barcelona 08003, Spain
| | - Magí Farré
- Clinical Pharmacology Department, Hospital Universitari Germans Trias I Pujol (IGTP), Badalona 08916, Spain; Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Marta Torrens
- Universitat Autònoma de Barcelona, Bellaterra 08193, Spain; Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona 08003, Spain.
| |
Collapse
|
16
|
Kaner EFS, Beyer FR, Garnett C, Crane D, Brown J, Muirhead C, Redmore J, O'Donnell A, Newham JJ, de Vocht F, Hickman M, Brown H, Maniatopoulos G, Michie S. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017; 9:CD011479. [PMID: 28944453 PMCID: PMC6483779 DOI: 10.1002/14651858.cd011479.pub2] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Excessive alcohol use contributes significantly to physical and psychological illness, injury and death, and a wide array of social harm in all age groups. A proven strategy for reducing excessive alcohol consumption levels is to offer a brief conversation-based intervention in primary care settings, but more recent technological innovations have enabled people to interact directly via computer, mobile device or smartphone with digital interventions designed to address problem alcohol consumption. OBJECTIVES To assess the effectiveness and cost-effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol-related problems, or both, in people living in the community, specifically: (i) Are digital interventions more effective and cost-effective than no intervention (or minimal input) controls? (ii) Are digital interventions at least equally effective as face-to-face brief alcohol interventions? (iii) What are the effective component behaviour change techniques (BCTs) of such interventions and their mechanisms of action? (iv) What theories or models have been used in the development and/or evaluation of the intervention? Secondary objectives were (i) to assess whether outcomes differ between trials where the digital intervention targets participants attending health, social care, education or other community-based settings and those where it is offered remotely via the internet or mobile phone platforms; (ii) to specify interventions according to their mode of delivery (e.g. functionality features) and assess the impact of mode of delivery on outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, ERIC, HTA and Web of Knowledge databases; ClinicalTrials.com and WHO ICTRP trials registers and relevant websites to April 2017. We also checked the reference lists of included trials and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effectiveness of digital interventions compared with no intervention or with face-to-face interventions for reducing hazardous or harmful alcohol consumption in people living in the community and reported a measure of alcohol consumption. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 57 studies which randomised a total of 34,390 participants. The main sources of bias were from attrition and participant blinding (36% and 21% of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta-analysis, which demonstrated that participants using a digital intervention drank approximately 23 g alcohol weekly (95% CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate-quality evidence).Fifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate-quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate-quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate-quality evidence).Only five small studies (390 participants) compared digital and face-to-face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95% CI -24.59 to 25.63; low-quality evidence). Thus, digital alcohol interventions produced broadly similar outcomes in these studies. No studies reported whether any adverse effects resulted from the interventions.A median of nine BCTs were used in experimental arms (range = 1 to 22). 'B' is an estimate of effect (MD in quantity of drinking, expressed in g/week) per unit increase in the BCT, and is a way to report whether individual BCTs are linked to the effect of the intervention. The BCTs of goal setting (B -43.94, 95% CI -78.59 to -9.30), problem solving (B -48.03, 95% CI -77.79 to -18.27), information about antecedents (B -74.20, 95% CI -117.72 to -30.68), behaviour substitution (B -123.71, 95% CI -184.63 to -62.80) and credible source (B -39.89, 95% CI -72.66 to -7.11) were significantly associated with reduced alcohol consumption in unadjusted models. In a multivariable model that included BCTs with B > 23 in the unadjusted model, the BCTs of behaviour substitution (B -95.12, 95% CI -162.90 to -27.34), problem solving (B -45.92, 95% CI -90.97 to -0.87), and credible source (B -32.09, 95% CI -60.64 to -3.55) were associated with reduced alcohol consumption.The most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51%) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness. AUTHORS' CONCLUSIONS There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low-quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face-to-face interventions.The BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context.Reporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness.
Collapse
Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Claire Garnett
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - David Crane
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Jamie Brown
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James Redmore
- University of BristolPopulation Health Sciences, Bristol Medical School39 Whatley RoadBristolUKBS8 2PS
| | - Amy O'Donnell
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - James J Newham
- King's College LondonPrimary Care & Public Health SciencesAddison House, Guy's campusLondonUKSE1 1UL
| | - Frank de Vocht
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Matthew Hickman
- University of BristolSchool of Social and Community Medicine39 Whatley RoadBristolUKBS8 2PS
| | - Heather Brown
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Gregory Maniatopoulos
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Susan Michie
- University College LondonResearch Department of Clinical, Educational and Health Psychology1‐19 Torrington PlaceLondonUKWC1E 7HB
| | | |
Collapse
|
17
|
Aardoom JJ, Dingemans AE, van Ginkel JR, Spinhoven P, Van Furth EF, Van den Akker-van Marle ME. Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial. Int J Eat Disord 2016; 49:1068-1076. [PMID: 27441418 DOI: 10.1002/eat.22587] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the cost-utility of the internet-based intervention "Featback" provided with different levels of therapist support, in comparison to a waiting list. METHOD This economic evaluation was conducted from a societal perspective and was part of a randomized controlled trial in which participants (N = 354) with self-reported ED symptoms were randomized to: (1) 8 weeks of Featback, consisting of psychoeducation and a fully automated monitoring- and feedback system, (2) Featback with low-intensity (weekly) therapist support, (3) Featback with high-intensity (three times a week) therapist support, and (4) a waiting list. Participants were assessed at baseline, postintervention, and 3-month follow-up. Cost-utility acceptability curves were constructed. RESULTS No significant differences between the study conditions were found regarding quality-adjusted life-years (P = 0.55) and societal costs (P = 0.45), although the mean costs per participant were lowest in the Featback condition with low-intensity therapist support (€1951), followed by Featback with high-intensity therapist support (€2032), Featback without therapist support (€2102), and the waiting list (€2582). Featback seemed to be cost-effective as compared to the waiting list. No clear preference was found for Featback with or without therapist support. DISCUSSION A fully automated Internet-based intervention for ED symptoms with no, low-, or high-intensity therapist support represented good value for money when compared to a waiting list. This finding may have important implications for clinical practice, as both the unguided- and guided intervention could allow for more efficient care and widespread dissemination, potentially increasing the accessibility and availability of mental health care services for individuals with ED symptoms. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1068-1076).
Collapse
Affiliation(s)
- J J Aardoom
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - A E Dingemans
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - J R van Ginkel
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - P Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - E F Van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
18
|
Drost RMWA, Paulus ATG, Jander AF, Mercken L, de Vries H, Ruwaard D, Evers SMAA. A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits. J Med Internet Res 2016; 18:e93. [PMID: 27103154 PMCID: PMC4858595 DOI: 10.2196/jmir.5223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/23/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background 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). Objective 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). Methods 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. Results 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. Conclusions 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. Trial Registration Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG)
Collapse
Affiliation(s)
- Ruben M W A Drost
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
| | | | | | | | | | | | | |
Collapse
|
19
|
Donker T, Blankers M, Hedman E, Ljótsson B, Petrie K, Christensen H. Economic evaluations of Internet interventions for mental health: a systematic review. Psychol Med 2015; 45:3357-3376. [PMID: 26235445 DOI: 10.1017/s0033291715001427] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is. METHOD A comprehensive literature search (1990-2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group. RESULTS Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines. CONCLUSIONS Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.
Collapse
Affiliation(s)
- T Donker
- Department of Clinical Psychology,VU University,Amsterdam,The Netherlands
| | - M Blankers
- Trimbos Institute,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - E Hedman
- Department of Clinical Neuroscience,Osher Center for Integrative Medicine,Karolinska Institutet,Stockholm,Sweden
| | - B Ljótsson
- Department of Clinical Neuroscience, Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - K Petrie
- The Black Dog Institute,University of New South Wales,Sydney,NSW,Australia
| | - H Christensen
- The Black Dog Institute,University of New South Wales,Sydney,NSW,Australia
| |
Collapse
|
20
|
Bhui KS, Aslam RW, Palinski A, McCabe R, Johnson MRD, Weich S, Singh SP, Knapp M, Ardino V, Szczepura A. Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review. Br J Psychiatry 2015; 207:95-103. [PMID: 26243761 PMCID: PMC4523926 DOI: 10.1192/bjp.bp.114.158899] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. AIMS To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. METHOD Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the 'grey' literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. RESULTS Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18-0.75) than for moderate- or lower-quality studies (range of d 0.18-4.3). The review found only two studies offering weak economic evidence. CONCLUSIONS Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.
Collapse
Affiliation(s)
- Kamaldeep S. Bhui
- Correspondence: K. S. Bhui, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6Q, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Grey M, Liberti L, Whittemore R. Costs of Development and Maintenance of an Internet Program for Teens with Type 1 Diabetes. HEALTH AND TECHNOLOGY 2015. [PMID: 26213677 DOI: 10.1007/s12553-015-0109-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many adolescents with type 1 diabetes (T1D) have difficulty completing self-management tasks within the context of their social environments. Group-based approaches to psycho-educational support have been shown to prevent declines in glucose control, but are challenging to implement due to youths' many activities and costs. A novel solution is providing psycho-educational support via the internet. The purpose of this study is to describe the cost of developing and maintaining two internet psycho-educational programs, both of which have been shown to improve health outcomes in adolescents with T1D. We calculated actual costs of personnel and programming in the development of TEENCOPE™ and Managing Diabetes, two highly interactive programs that were evaluated in a multi-site clinical trial (n=320). Cost calculations were set at U.S. dollars and converted to value for 2013 as expenses were incurred over 6 years. Development costs over 1.5 years totaled $324,609, with the majority of costs being for personnel to develop and write content in a creative and engaging format, to get feedback from teens on content and a prototype, and IT programming. Maintenance of the program, including IT support, a part-time moderator to assure safety of the discussion board (0.5-1 hour/week), and yearly update of content was $43,845/year, or $137.00 per youth over 4.5 years. Overall, program and site development were relatively expensive, but the program reach was high, including non-white youth from 4 geographically distinct regions. Once developed, maintenance was minimal. With greater dissemination, cost-per-youth would decrease markedly, beginning to offset the high development expense.
Collapse
Affiliation(s)
- Margaret Grey
- Yale University School of Nursing, New Haven, Connecticut
| | - Lauren Liberti
- Yale University School of Nursing, New Haven, Connecticut
| | | |
Collapse
|
22
|
Bergmo TS. Using QALYs in telehealth evaluations: a systematic review of methodology and transparency. BMC Health Serv Res 2014; 14:332. [PMID: 25086443 PMCID: PMC4132195 DOI: 10.1186/1472-6963-14-332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/21/2014] [Indexed: 02/08/2023] Open
Abstract
Background The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations. Methods Evaluations were identified via a literature search in all relevant databases. Only economic evaluations measuring both costs and QALYs using primary patient level data of two or more alternatives were included. Results A total of 17 economic evaluations estimating QALYs were identified. All evaluations used validated generic health related-quality of life (HRQoL) instruments to describe health states. They used accepted methods for transforming the quality scores into utility values. The methodology used varied between the evaluations. The evaluations used four different preference measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population. Most studies reported the methodology used in calculating QALYs. The evaluations were less transparent in reporting utility weights at different time points and variability around utilities and QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth intervention on patient’s health. The evaluations reported mixed cost-effectiveness results. Conclusion The use of QALYs in telehealth evaluations has increased over the last few years. Different methodologies and utility measures have been used to calculate QALYs. A more harmonised methodology and utility measure is needed to ensure comparability across telehealth evaluations.
Collapse
Affiliation(s)
- Trine S Bergmo
- Norwegian Centre for Telemedicine and Integrated Care, University Hospital of North Norway, N-9038 Tromsø Norway.
| |
Collapse
|
23
|
Ho RC, Zhang MWB, Tsang TY, Toh AH, Pan F, Lu Y, Cheng C, Yip PS, Lam LT, Lai CM, Watanabe H, Mak KK. The association between internet addiction and psychiatric co-morbidity: a meta-analysis. BMC Psychiatry 2014; 14:183. [PMID: 24947851 PMCID: PMC4082374 DOI: 10.1186/1471-244x-14-183] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/11/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature. METHODS Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR). RESULTS Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001). CONCLUSIONS IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.
Collapse
Affiliation(s)
- Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Melvyn WB Zhang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tammy Y Tsang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anastasia H Toh
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Pan
- Department of Medical Psychology, Shandong University, Shandong, China
| | - Yanxia Lu
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cecilia Cheng
- Department of Psychology, University of Hong Kong, Hong Kong
| | - Paul S Yip
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong
| | - Lawrence T Lam
- Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ching-Man Lai
- Department of Psychology, Chinese University of Hong Kong, Hong Kong
| | - Hiroko Watanabe
- Department of Children and Women’s Health, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kwok-Kei Mak
- Department of Community Medicine and School of Public Health, Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
| |
Collapse
|
24
|
Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis. PLoS One 2014; 9:e99912. [PMID: 24937483 PMCID: PMC4061051 DOI: 10.1371/journal.pone.0099912] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/19/2014] [Indexed: 01/16/2023] Open
Abstract
Background Alcohol misuse ranks within the top ten health conditions with the highest global burden of disease. Low-intensity, Internet interventions for curbing adult alcohol misuse have been shown effective. Few meta-analyses have been carried out, however, and they have involved small numbers of studies, lacked indicators of drinking within low risk guidelines, and examined the effectiveness of unguided self-help only. We therefore conducted a more thorough meta-analysis that included both guided and unguided interventions. Methods Systematic literature searches were performed up to September 2013. Primary outcome was the mean level of alcohol consumption and drinking within low risk guidelines for alcohol consumption at post-treatment. Findings We selected 16 randomised controlled trials (with 23 comparisons and 5,612 participants) for inclusion. Results, showed a small but significant overall effect size in favour of Internet interventions (g = 0.20, 95% CI: 0.13–0.27, p<.001). Participants in Internet interventions drunk on average 22 grams of ethanol less than controls and were significantly more likely to be adhering to low-risk drinking guidelines at post-treatment (RD 0.13, 95% CI: 0.09–0.17, p<.001). Subgroup analyses revealed no significant differences in potential moderators for the outcome of alcohol consumption, although there was a near-significant difference between comparisons with waitlist control and those with assessment-only or alcohol information control conditions (p = .056). Conclusions Internet interventions are effective in reducing adult alcohol consumption and inducing alcohol users to adhere to guidelines for low-risk drinking. This effect is small but from a public health point of view this may warrant large scale implementation at low cost of Internet interventions for adult alcohol misuse. Moderator analyses with sufficient power are, however, needed in order to assess the robustness of these overall results and to assess whether these interventions may impact on subgroups with different levels of success.
Collapse
|
25
|
Sinadinovic K, Wennberg P, Johansson M, Berman AH. Targeting individuals with problematic alcohol use via Web-based cognitive-behavioral self-help modules, personalized screening feedback or assessment only: a randomized controlled trial. Eur Addict Res 2014; 20:305-18. [PMID: 25300885 DOI: 10.1159/000362406] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Most problematic alcohol users never seek professional help to reduce their use, and Web-based interventions might fulfill users' unmet needs for professional support. METHODS This randomized controlled trial compared two open Web-based interventions, one extended self-help program and one brief screening and feedback intervention, with an assessment-only control group. Participants were 633 Internet help seekers with at least hazardous alcohol use (Alcohol Use Disorders Identification Test, AUDIT ≥6 for women and ≥8 for men). RESULTS All groups reduced their alcohol use at 3-month follow-up (p < 0.001), remaining stable at the 6- and 12-month follow-ups (n.s.) according to AUDIT-C and AUDIT scores (intention-to-treat, ITT, analysis). Per protocol (PP) analysis, including only participants who accessed the interventions and also reported accessing additional outside interventions during the trial, showed that about 75% of extended self-help participants moved from probable dependence, harmful or hazardous use to lower alcohol use levels at 3- and 6- and 12-month follow-ups, compared to about 40-60% of brief intervention users and controls who accessed extra help (p < 0.05). CONCLUSION ITT analysis suggested parity over time for all interventions, including assessment only, in reducing problematic alcohol use. In contrast, PP analysis suggested that cognitive-behavioral extended self-help in combination with other interventions was more effective in changing alcohol use than brief intervention or assessment only.
Collapse
Affiliation(s)
- Kristina Sinadinovic
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|
26
|
Internet and computer based interventions for cannabis use: a meta-analysis. Drug Alcohol Depend 2013; 133:295-304. [PMID: 23747236 DOI: 10.1016/j.drugalcdep.2013.05.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Worldwide, cannabis is the most prevalently used illegal drug and creates demand for prevention and treatment services that cannot be fulfilled using conventional approaches. Computer and Internet-based interventions may have the potential to meet this need. Therefore, we systematically reviewed the literature and conducted a meta-analysis on the effectiveness of this approach in reducing the frequency of cannabis use. METHODS We systematically searched online databases (Medline, PubMed, PsychINFO, Embase) for eligible studies and conducted a meta-analysis. Studies had to use a randomized design, be delivered either via the Internet or computer and report separate outcomes for cannabis use. The principal outcome measure was the frequency of cannabis use. RESULTS Data were extracted from 10 studies and the meta-analysis involved 10 comparisons with 4,125 participants. The overall effect size was small but significant, g=0.16 (95% confidence interval (CI) 0.09-0.22, P<0.001) at post-treatment. Subgroup analyses did not reveal significant subgroup differences for key factors including type of analysis (intention-to-treat, completers only), type of control (active, waitlist), age group (11-16, 17+ years), gender composition (female only, mixed), type of intervention (prevention, 'treatment'), guided versus unguided programs, mode of delivery (Internet, computer), individual versus family dyad and venue (home, research setting). Also, no significant moderation effects were found for number of sessions and time to follow-up. Finally, there was no evidence of publication bias. CONCLUSIONS Internet and computer interventions appear to be effective in reducing cannabis use in the short-term albeit based on data from few studies and across diverse samples.
Collapse
|
27
|
Sonntag M, König HH, Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. PHARMACOECONOMICS 2013; 31:1131-54. [PMID: 24293216 DOI: 10.1007/s40273-013-0107-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. METHODS We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). RESULTS We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. LIMITATIONS We only searched four databases and did not evaluate the quality of the included studies. CONCLUSIONS Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.
Collapse
Affiliation(s)
- Michael Sonntag
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
| | | | | |
Collapse
|
28
|
Bewick BM, West RM, Barkham M, Mulhern B, Marlow R, Traviss G, Hill AJ. The effectiveness of a Web-based personalized feedback and social norms alcohol intervention on United Kingdom university students: randomized controlled trial. J Med Internet Res 2013; 15:e137. [PMID: 23883616 PMCID: PMC3742391 DOI: 10.2196/jmir.2581] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/10/2013] [Accepted: 05/23/2013] [Indexed: 11/27/2022] Open
Abstract
Background Alcohol consumption in the student population continues to be cause for concern. Building on the established evidence base for traditional brief interventions, interventions using the Internet as a mode of delivery are being developed. Published evidence of replication of initial findings and ongoing development and modification of Web-based personalized feedback interventions for student alcohol use is relatively rare. The current paper reports on the replication of the initial Unitcheck feasibility trial. Objective To evaluate the effectiveness of Unitcheck, a Web-based intervention that provides instant personalized feedback on alcohol consumption. It was hypothesized that use of Unitcheck would be associated with a reduction in alcohol consumption. Methods A randomized control trial with two arms (control=assessment only; intervention=fully automated personalized feedback delivered using a Web-based intervention). The intervention was available week 1 through to week 15. Students at a UK university who were completing a university-wide annual student union electronic survey were invited to participate in the current study. Participants (n=1618) were stratified by sex, age group, year of study, self-reported alcohol consumption, then randomly assigned to one of the two arms, and invited to participate in the current trial. Participants were not blind to allocation. In total, n=1478 (n=723 intervention, n=755 control) participants accepted the invitation. Of these, 70% were female, the age ranged from 17-50 years old, and 88% were white/white British. Data were collected electronically via two websites: one for each treatment arm. Participants completed assessments at weeks 1, 16, and 34. Assessment included CAGE, a 7-day retrospective drinking diary, and drinks consumed per drinking occasion. Results The regression model predicted a monitoring effect, with participants who completed assessments reducing alcohol consumption over the final week. Further reductions were predicted for those allocated to receive the intervention, and additional reductions were predicted as the number of visits to the intervention website increased. Conclusions Unitcheck can reduce the amount of alcohol consumed, and the reduction can be sustained in the medium term (ie, 19 weeks after intervention was withdrawn). The findings suggest self-monitoring is an active ingredient to Web-based personalized feedback.
Collapse
Affiliation(s)
- Bridgette M Bewick
- Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|