Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care Luqman Tariq1*, Matthijs van den Berg2, Rudolf T. Hoogenveen1, Pieter H. M. van Baal1 1 Centre for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands, 2 Centre for Public Health Forecasting, National Institute of Public Health and the Environment, Bilthoven, The Netherlands Abstract Background: Effective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers. Methodology and Results: We compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of J298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of J5,400 per QALY gained. Conclusion: Prevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective. Citation: Tariq L, van den Berg M, Hoogenveen RT, van Baal PHM (2009) Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care. PLoS ONE 4(5): e5696. doi:10.1371/journal.pone.0005696 Editor: Syed Ahmer, Aga Khan University Karachi, Pakistan Received January 7, 2009; Accepted April 10, 2009; Published May 27, 2009 Copyright: 2009 Tariq et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was financially supported by the Ministry of Health, Welfare and Sport of The Netherlands. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: luqman.tariq@rivm.nl Introduction Excessive alcohol use is a cause of morbidity and even mortality, as it increases risks of coronary heart disease, stroke, and several types of cancers, with associated losses of life-years and quality of life [1,2,3]. In addition, substantial disability from medical and psychiatric consequences, injuries and ‘‘secondhand’’ effects (e.g. motor vehicle crashes) are attributed to excessive use of alcohol [4]. In the Netherlands, about 1% of total mortality, 4.5% of the public burden of disease and 0.6% of total health care costs (in 2003) can be attributed to chronic diseases caused by excessive alcohol consumption [5]. Currently, about 14% of Dutch men aged 12 or above drink more than three alcoholic consumptions per day and about 10% of the Dutch women aged 12 or above drink more than two alcoholic consumptions per day [6]. As a result, effective prevention of excessive alcohol use has the potential to reduce the burden of disease in the Netherlands considerably. Brief intervention for excessive alcohol use in primary care settings is an effective intervention [7,8,9,10,11]. In a randomized study, Fleming et al. [7,8] found significant reductions in 7-day alcohol use in patients who received brief physician advice 12 months after the intervention. Senft et al. [9] also found significant reductions in numbers of weekly drinking days 12 months after receiving the brief intervention. Bertholet et al. [10] indicated that brief intervention in primary care resulted in a reduction in weekly ethanol intake of 38 grams per person. Also randomized trials conducted in other settings have demonstrated a reduction in the intake of alcohol by three to nine drinks per week, as compared to the control group [11]. In order to recognize and treat patients with alcohol problems, an opportunistic screening program should be included in the general practices. Fiellin et al. [12] evaluated the accuracy of screening methods for alcohol problems in primary care. The Alcohol Use Disorders Identifica- tion Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking. Sensitivity of this questionnaire ranged from 51% to 97%, while specificity ranged from 78% to 96%. While screening would be opportunistic and not targeted at any group specifically, brief intervention is targeted at groups with a high risk to be(come) an excessive drinker in primary care. High risk groups are defined as women who drink 2 or more standard alcohol drinks (i.e. .20 grams ethanol) per day; and men who drink 4 or more standard alcohol drinks (i.e. .40 grams ethanol) per day; without meeting the DSM-IV criteria for alcohol dependency [13]. In the present study, we performed a cost-effectiveness analysis (CEA) of SBI in primary care patients. The outcome of this CEA is expressed as a ratio of incremental costs relative to incremental effects of the intervention: the incremental cost-effectiveness ratio PLoS ONE | www.plosone.org 1 May 2009 | Volume 4 | Issue 5 | e5696