title: The cost-effectiveness of tailored, postal feedback on general practitioners' prescribing of pharmacotherapies for alcohol dependence.
abstract: OBJECTIVE
  The aims of this study were to conduct a randomised controlled trial to evaluate the cost-effectiveness of tailored, postal feedback on general practitioners' (GPs) prescribing of acamprosate and naltrexone for alcohol dependence relative to current practice and its impact on alcohol dependence morbidity.
  
  
  METHODS
  Rural communities in New South Wales, Australia, were randomised into experimental (N=10) and control (N=10) communities. Tailored feedback on their prescribing of alcohol pharmacotherapies was mailed to GPs from the experimental communities (N=115). Segmented regression analysis was used to examine within and between group changes in prescribing and alcohol dependence hospitalisation rates compared to the control communities. Incremental cost-effectiveness ratios (ICERs) were estimated per additional prescription of pharmacotherapies and per alcohol dependence hospitalisation(s) averted.
  
  
  RESULTS
  Post-intervention changes, relative to the control communities, in GPs' prescribing rate trends in the experimental communities significantly increased for acamprosate (β=0.24, 95% CI: 0.13-0.35, p<0.001), and significantly decreased for naltrexone (β = -0.12, 95% CI: -0.17 to -0.06) per quarter. Quarterly hospitalisation trend rates for alcohol dependence, as principal diagnosis, significantly decreased (β=-0.07, 95% CI: -0.13 to -0.01, p<0.05), compared to control communities. The median ICER per quarterly hospitalisation(s) averted due to intervention was dominant (dominant--$12,750).
  
  
  CONCLUSIONS
  Postal, tailored feedback to GPs on their prescribing of acamprosate and naltrexone for alcohol dependence was a cost-effective intervention, in rural communities of NSW, to increase the overall prescribing of pharmacotherapies with a plausible effect on incidence reduction of hospitalisations for alcohol dependence as principal diagnosis.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Building R3, 22-32 King Street, Randwick Campus, Sydney, NSW 2031, Australia. h.navarro@unsw.edu.au
authors.forename: Héctor José
authors.initials: HJ
authors.lastname: Navarro
authors.forename: Anthony
authors.initials: A
authors.lastname: Shakeshaft
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Doran
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Petrie
mesh_terms: D000077443:Acamprosate; D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000191:economics / Q000627:therapeutic use*; D009517:New South Wales; D011177:Postal Service; D010818:Practice Patterns, Physicians' / Q000191:economics*; D013654:Taurine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate