2. Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to Emergency Departments: three-arm pragmatic randomised trial

Friday, 25 November, 2022 - 13:20 to 14:50

Abstract

Alcohol use increases throughout adolescence. Emergency Department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. Method/ approach OR Design and methods We conducted a multi-centre, three-group, single-blind, individually randomised trial across ten EDs in England with follow-ups after 6- and 12-months. From October 2014 to May 2015, we screened 3,327 adolescents, aged 14 to 18, of whom 756 (22.7%) scored at least 3 on AUDIT-C and consented to participate in this trial. Mean age was 16.1 years; 50.2% were females and 84.9% were white.

Interventions were personalised feedback and brief advice (PFBA), personalised feedback plus electronic brief intervention (eBI) and alcohol screening alone (SA). The primary outcome was the weekly alcohol consumed in standard UK units (8 grams of ethanol) at 12-months post-randomisation, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both NHS & personal social services and society.

At 12-months mean weekly consumption was 2.99 (95% C.I. from 2.38 to 3.70) standard units for SA group, 3.56 (2.90, 4.32) for PFBA, and 3.18 (2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs 0.19 consumed (- 0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective economic analysis showed PFBA and eBI were not cost-effective compared to SA: PFBA yielded incremental cost-effectiveness ratio of £6,213 (-£736,843, £812,884), with the intervention having 54% probability of being cost-effective compared to SA at the £20,000 WTP threshold.

We successfully implemented both interventions in ED. Neither showed evidence of being effective or cost-effective when compared to SA in reducing alcohol consumption among adolescents.

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