A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits.
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.


BACKGROUND
Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG).
Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands. r.drost@maastrichtuniversity.nl.
Ruben M W A
http://orcid.org/0000-0002-7428-040X
RM
Drost
Aggie T G
http://orcid.org/0000-0002-2086-6106
AT
Paulus
Astrid F
http://orcid.org/0000-0003-0863-3884
AF
Jander
Liesbeth
http://orcid.org/0000-0002-5719-7647
L
Mercken
Hein
http://orcid.org/0000-0002-3640-2517
H
de Vries
Dirk
http://orcid.org/0000-0003-4887-8413
D
Ruwaard
Silvia M  A A
http://orcid.org/0000-0003-1026-570X
SM
Evers
D000293:Adolescent; D000428:Alcohol Drinking / Q000517:prevention & control*; D063425:Binge Drinking / Q000517:prevention & control; D003194:Computer-Assisted Instruction / Q000191:economics*; D003362:Cost-Benefit Analysis; D005246:Feedback; D005260:Female; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006801:Humans; D020407:Internet / Q000191:economics*; D008019:Life Style; D008297:Male; D009426:Netherlands; D012984:Software / Q000191:economics; D011795:Surveys and Questionnaires
adolescents; alcohol use; cluster randomized controlled trial; computer tailoring; costs and cost analysis; criminal justice; economic evaluation; education; game; intersectoral costs and benefits