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 randomized trial (SIPS Junior high risk trial)

Paolo Deluca, Simon Coulton, Mohammed Fasihul Alam, Sadie Boniface, Kim Donoghue, Eilish Gilvarry, Eileen Kaner, Ellen Lynch, Ian Maconochie, Paul McArdle, Ruth McGovern, Dorothy Newbury-Birch, Robert Patton, Tracy Pellat-Higgins, Ceri Phillips, Thomas Phillips, Rhys D. Pockett, Ian T. Russell, John Strang, Colin Drummond

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Abstract

Background and aims: 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. Design, Setting and Participants: Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. Interventions: Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. Measures: The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. Findings: At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38–3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 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 consumed 0.19 (−0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (−£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. Conclusions: In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.

Original languageEnglish
Pages (from-to)2200-2214
Number of pages15
JournalAddiction
Volume117
Issue number8
DOIs
Publication statusPublished - 21 Mar 2022

Bibliographical note

Funding Information:
J.S. reports competing interests with Molteni Farma, and grants from Mundipharma, Camurus and Accord Pharma outside the submitted work. K.E.K., N.‐B.D., P.R., P.‐H.T., P.C. and R.I.T. report grants from NIHR during the conduct of the study. S.B. works at the Institute of Alcohol Studies, which receives funding from the Alliance House Foundation. K.E.K. is now a panel member of NIHR PGfAR, which funded this study, but not at the time the work was conducted. P.C. received additional funding from the NIHR Yorkshire and Humber Clinical Research Network to support the development and delivery of clinical and applied health research across the region. The other authors have no conflicts of interest.

Funding Information:
We thank the participating EDs: St Thomas’ Hospital; King's College Hospital; Ealing Hospital; Croydon University Hospital; Hull Royal Infirmary; Darlington Memorial Hospital; Queen Elizabeth Hospital, Gateshead; North Tees Hospital, Hartlepool; South Tyneside District Hospital, South Shields; and Sunderland Royal Hospital; and all the researchers who successfully delivered the trial in these EDs. We thank the Trial Steering Committee and our software developers at Codeface Ltd for developing the trial management app. and the eBI app. SIPS City. This is a summary of independent research funded by a National Institute for Health Research (NIHR) Programme Grant for Applied Research (RP‐PG‐0609‐10162). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. C.D., P.D. and J.S. were supported by the NIHR Specialist Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. C.D. and P.D. were also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care at King's College Hospital NHS Foundation Trust and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. T.P. was funded by a NIHR Clinical Doctoral Research Fellowship and the NIHR Yorkshire and the Humber Clinical Research Network.

Funding Information:
We thank the participating EDs: St Thomas’ Hospital; King's College Hospital; Ealing Hospital; Croydon University Hospital; Hull Royal Infirmary; Darlington Memorial Hospital; Queen Elizabeth Hospital, Gateshead; North Tees Hospital, Hartlepool; South Tyneside District Hospital, South Shields; and Sunderland Royal Hospital; and all the researchers who successfully delivered the trial in these EDs. We thank the Trial Steering Committee and our software developers at Codeface Ltd for developing the trial management app. and the eBI app. SIPS City. This is a summary of independent research funded by a National Institute for Health Research (NIHR) Programme Grant for Applied Research (RP-PG-0609-10162). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. C.D., P.D. and J.S. were supported by the NIHR Specialist Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London. C.D. and P.D. were also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care at King's College Hospital NHS Foundation Trust and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. T.P. was funded by a NIHR Clinical Doctoral Research Fellowship and the NIHR Yorkshire and the Humber Clinical Research Network.

Publisher Copyright:
© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

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