Economic evaluations of interventions for alcohol misuse, dependence, and to reduce alcohol-related violent crime, at a community level in rural Australia

Abstract

Despite limited research, alcohol problems are recognised as disproportionately high in Australian rural communities. Primary care and other community-based approaches are increasing in importance as strategies for reducing alcohol problems in a defined population, especially quantifying their cost-effectiveness or cost-benefit. The overall aim of this thesis was to conduct economic evaluations of community-level interventions for alcohol misuse and harm, undertaken in conjunction with the Alcohol Action in Rural Communities project.

Chapter 2 is a systematic review of publications including costs of alcohol harm to others, which found that these costs are rarely reported, limiting the current accuracy of the true economic burden of alcohol misuse.

A decision model and scenario analysis is developed and applied in Chapter 3 to assess outcomes and costs for annual increments in general practitioner (GP)-delivered screening and brief intervention (BI) rates to risky drinkers at a community level. This is further adapted in Chapter 4 for pharmacist-delivered BI to risky drinking customers. Key results suggest that for both GPs and pharmacists the most likely cost-effective option, compared to current practice, is to increase screening alone for all visiting risky drinkers.

The randomised controlled trial (RCT) outlined in Chapter 5 found that mailed feedback to all GPs about their prescribing of acamprosate and naltrexone for alcohol dependence was a cost-effective strategy, relative to current practice, given the likelihood that it potentially generates hospital cost savings.

Chapter 6 quantified the costs and benefits of reductions in alcohol-related violent crime incidents, based on an RCT that targeted problematic weekends with a multi-strategy approach. The intervention was found to be cost-beneficial, with significant reductions for alcohol-related sexual offences on targeted weekends and potential diffusion of benefits from reduced alcohol-related assaults on non-targeted weekends.

Together, the findings from this thesis suggest that allocating resources to the interventions evaluated for joint implementation can enhance benefits for communities, in terms of reductions of alcohol misuse and the related burden of harm. Future attempts should be made to also quantify the benefit experienced by people other than the drinker.