Valuing eHealth: cost-effectiveness of a web-based computer-tailored alcohol prevention program for adolescents

Abstract

Background: A means to prevent excessive alcohol use is computer-tailoring, which is a behavioral intervention of which contents are adapted to individual characteristics of respondents. Such an intervention may lead to costs and benefits both within and outside the health care sector, also known as inter-sectoral costs and benefits (ICBs).The aim of this study is to conduct a cost-effectiveness analysis of a web-based computer-tailored alcohol reduction intervention for adolescents from both a societal (including ICBs) and health care perspective (excluding ICBs). Methods: Data was used from the Alcohol Alert study, a computer-tailored alcohol prevention program based on the I-Change model aimed at reducing binge drinking and weekly alcohol use among Dutch school going adolescents. Parametric uncertainty was dealt with using bootstrap analysis. We conducted sensitivity analyses by calculating additional incremental cost-effectiveness ratios based on excluding outliers. Findings: Results show a change in cost-effectiveness when changing perspective. However, from both perspectives the intervention is both more effective and costlier than CAU. The results of the sensitivity analyses support these findings. Subgroup analyses showed, from both perspectives, and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19) and those at a lower educational level. Discussion: The favorability of the intervention over CAU depends on willingness to pay per reduction of one binge drinking occasion per month or one glass of alcohol per week. Future studies are encouraged to assess the relation between the perspective chosen and the outcomes of its economic analysis.