title: A microsimulation cost-utility analysis of alcohol screening and brief intervention to reduce heavy alcohol consumption in Canada.
abstract: OBJECTIVE
  Screening and brief intervention (SBI) is a public health intervention that has been shown to be effective in reducing heavy alcohol consumption. The aim of this study is to estimate the cost-effectiveness of implementing universal alcohol SBI in primary care in Canada.
  
  
  METHODS
  We developed a microsimulation model of alcohol consumption and its effects on 18 alcohol-related causes of death.
  
  
  METHODS
  The model simulates a Canadian population.
  
  
  METHODS
  The model simulates individuals and their alcohol consumption on a continuous scale starting from age 17 years to death.
  
  
  METHODS
  The reference case assumes no SBI in Canada. The base case assumes screening was conducted using the Alcohol Use Disorders Identification Test (AUDIT) at a threshold score of 8. Additional analyses included evaluating SBI using the AUDIT at threshold scores between 4 and 8 or the Derived Alcohol Use Disorders Identification Test (AUDIT-C) at threshold scores between 3 and 7.
  
  
  METHODS
  The model estimates the direct health-care costs, life years gained and quality-adjusted life years (QALY) gained, which are then used to estimate the incremental cost-effectiveness ratio (ICER) of SBI versus no SBI.
  
  
  RESULTS
  SBI with AUDIT (at a threshold score of 8) had an ICER of $8729/QALY. Our results suggest that using AUDIT thresholds between 8 and 4, inclusive, would be cost-effective for the whole population, as well as for men and women individually. Our results suggest that the AUDIT-C would be cost-effective at thresholds of 7 to 3, inclusive, for men, women and the whole population.
  
  
  CONCLUSIONS
  In Canada, screening and brief intervention via Alcohol Use Disorders Identification Test (AUDIT) and Derived Alcohol Use Disorders Identification Test (AUDIT-C) to reduce heavy alcohol consumption appears to be cost-effective for men and women at Alcohol Use Disorders Identification Test (AUDIT) thresholds of 8 and lower and at Derived Alcohol Use Disorders Identification Test (AUDIT-C) thresholds of 7 and lower.
authors.affiliation: Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.|Optum, Burlington, Ontario, Canada.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Zur
authors.affiliation: Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada.|Epidemiology and Biostatistics, The University of Western Ontario, Ontario, Canada.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Zaric
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000191:economics / Q000517:prevention & control*; D002170:Canada; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011614:Psychotherapy, Brief / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D055815:Young Adult
keywords: Cost-utility analysis; microsimulation; screening and brief intervention