Outcomes of a health economic evaluation of digital alcohol and tobacco interventions for cancer survivors alongside randomized controlled trials

Digital interventions may contribute to reduce the considerable prevalence of smoking and alcohol use above guidelines among cancer survivors. We evaluated two new digital interventions (MyCourse-Moderate Drinking and MyCourse-Quit Smoking) on effectiveness and cost-effectiveness.

We conducted a health economic evaluation alongside two separate two-arm randomised controlled trials (RCTs) in The Netherlands from 2016 to 2019: an alcohol moderation trial (AMT) and a smoking cessation trial (SCT), with follow-ups at 3, 6 and 12 months post-baseline. Participants were adult cancer survivors, currently smoking or drinking alcohol above Dutch guidelines (>7 units per week). We included 165 participants in the SCT and 103 participants in the AMT. Experimental group participants could access MyCourse. Control group participants received an online information brochure on smoking or alcohol. Primary outcomes were self-reported 7-day smoking abstinence (SCT) and 7-day alcohol use (AMT). For the health economic evaluation, healthcare and intervention costs, and costs due to productivity losses were assessed over a 12-month horizon.

After 6 months, quit rates in the SCT were 27.7% (MyCourse group) and 25.6% (control group). In the AMT alcohol use declined by 38% in the MyCourse group and by 33% in the control group. No significant difference in quit rates (OR=0.47;95%CI 0.03-7.86;P=.60) or 7-day alcohol use (B=2.1;95%CI −7.6-3.1;P=.22) was found between groups. The MyCourse group led to marginally more reduced pack-years against higher societal costs, with a mean incremental cost-effectiveness ratio (ICER) of US$52,067 (95%CI 32,515-81,346), while in the AMT the MyCourse group led to a larger reduction in drinking units at lower societal costs (ICER per reduced drink US$−1,158, 95%CI −1,609 to −781).

This is one of few studies that have evaluated the cost-effectiveness of digital alcohol and tobacco interventions. The findings are mixed, but indicate that digital interventions for cancer survivors might be preferred over an information brochure.