Economic evaluation of internet-based interventions for harmful alcohol use alongside a pragmatic randomized controlled trial

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. trial registration: netherlands trial register ntr-tc1155; http://www.trialregister.nl/trialreg/ admin/rctview.asp?tc=1155 (archived by webcite at http://www.webcitation.org/ 6aqnv4etu).