title: Economic evaluation of internet-based interventions for harmful alcohol use alongside a pragmatic randomized controlled trial.
abstract: BACKGROUND
  Internet interventions with and without therapist support have been found to be effective treatment options for harmful alcohol users. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS), but it is also more costly to provide.
  
  
  OBJECTIVE
  To evaluate the cost effectiveness and cost utility of Internet-based interventions for harmful use of alcohol through the assessment of the incremental cost effectiveness of IT compared with IS.
  
  
  METHODS
  This study was performed in a substance abuse treatment center in Amsterdam, the Netherlands. We collected data over the years 2008-2009. A total of 136 participants were included, 70 (51%) were female, and mean age was 41.5 (SD 9.83) years. Reported alcohol consumption and Alcohol Use Disorders Identification Test (AUDIT) scores indicated harmful drinking behavior at baseline. We collected self-reported outcome data prospectively at baseline and 6 months after randomization. Cost data were extracted from the treatment center's cost records, and sex- and age-specific mean productivity cost data for the Netherlands.
  
  
  RESULTS
  The median incremental cost-effectiveness ratio was estimated at €3683 per additional treatment responder and €14,710 per quality-adjusted life-year (QALY) gained. At a willingness to pay €20,000 for 1 additional QALY, IT had a 60% likelihood of being more cost effective than IS. Sensitivity analyses attested to the robustness of the findings.
  
  
  CONCLUSIONS
  IT offers better value for money than IS and might therefore be considered as a treatment option, either as first-line treatment in a matched-care approach or as a second-line treatment in the context of a stepped-care approach.
  
  
  BACKGROUND
  Netherlands Trial Register NTR-TC1155; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1155 (Archived by WebCite at http://www.webcitation.org/6AqnV4eTU).
authors.affiliation: Department Jellinek, Arkin Mental Health Care, Amsterdam, Netherlands. m.blankers@amc.uva.nl
authors.forename: Matthijs
authors.initials: M
authors.lastname: Blankers
authors.forename: Udo
authors.initials: U
authors.lastname: Nabitz
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Schippers
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009426:Netherlands