Long-term outcomes of a digital alcohol intervention targeting online help-seekers: a simulation study of incidence of disease, quality-adjusted life-years and costs
Katarina Ulfsdotter Gunnarsson, Martin Henriksson, Marcus BendtsenIntroduction
Harmful and hazardous alcohol consumption is a major public health concern and places considerable burdens on societies. Digital alcohol interventions (DAIs) are promising tools to support behaviour change, yet the extent to which their behavioural effects translate into long-term health benefits is unclear. This study aimed to develop and apply an individual-level simulation model to estimate the long-term outcomes of a DAI.
Methods
We developed an individual-level simulation model to simulate the life course of individuals in two virtual cohorts: one receiving a DAI cohort and the other receiving treatment-as-usual (TAU cohort). We contrasted incidence rates for ten alcohol-related diseases, quality-adjusted life-years (QALYs) and healthcare costs between the cohorts. We also calculated an incremental cost-effectiveness ratio.
Results
The results indicated that when assuming a sustained population-level intervention effect over time, the DAI cohort experienced lower incidence rates of most alcohol-related diseases compared with the TAU cohort. The intervention also yielded a marginally higher per individual QALY (0.008, IQR=−0.007; 0.023) compared with treatment as usual, as well as a lower cost (€−89, IQR=€−147; €−30). When the population-level effect was assumed halved or slowly waning over time the results were similar but attenuated, and when assumed to wane more rapidly, there were no marked differences between cohorts. While the digital intervention could be considered a dominant strategy, considerable uncertainty remained in the cost-effectiveness plane when exploring varying assumptions about the effectiveness.
Conclusions
DAIs could play a role in a comprehensive public health strategy aimed at reducing alcohol consumption. However, challenges remain to produce stronger evidence for their cost-effectiveness, not least addressing the lack of data on persistent effects. The realisation of these benefits in practice depends on effective implementation, including sustained investment in dissemination and monitoring of their use.