The cost-effectiveness of tailored, postal feedback on general practitioners’ prescribing of pharmacotherapies for alcohol dependence

• Published in: Drug and alcohol dependence Vol. 124; no. 3; pp. 207 - 215
• Main Authors: Navarro, Héctor José, Shakeshaft, Anthony, Doran, Christopher M, Petrie, Dennis J
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.08.2012; Elsevier
• Subjects: Acamprosate; Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Alcohol dependence; Alcoholism; Alcoholism - drug therapy; Alcoholism - economics; Alcoholism and acute alcohol poisoning; Biological and medical sciences; Cost effectiveness; Cost-Benefit Analysis; Drug addiction; Feedback; Female; General practitioner; General Practitioners; Humans; Male; Medical sciences; Naltrexone - economics; Naltrexone - therapeutic use; New South Wales; Pharmacology; Postal Service; Postal tailored feedback; Practice Patterns, Physicians' - economics; Prescribing; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Taurine - analogs & derivatives; Taurine - economics; Taurine - therapeutic use; Toxicology; New South Wales; Postal tailored feedback; Alcohol dependence; General practitioner; Cost-effectiveness; Human; Drug; Drug addiction; Alcoholism; Pharmacotherapy; Feedback regulation; Alcoholic beverage; Chemotherapy; Treatment; Addiction; Medical prescription; Health economy; Dependence; Cost efficiency analysis
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2012.01.007

Abstract Aims The aims of this study were to conduct a randomised controlled trial to evaluate the cost-effectiveness of tailored, postal feedback on general practitioners’ (GPs) prescribing of acamprosate and naltrexone for alcohol dependence relative to current practice and its impact on alcohol dependence morbidity. Methods Rural communities in New South Wales, Australia, were randomised into experimental ( N = 10) and control ( N = 10) communities. Tailored feedback on their prescribing of alcohol pharmacotherapies was mailed to GPs from the experimental communities ( N = 115). Segmented regression analysis was used to examine within and between group changes in prescribing and alcohol dependence hospitalisation rates compared to the control communities. Incremental cost-effectiveness ratios (ICERs) were estimated per additional prescription of pharmacotherapies and per alcohol dependence hospitalisation(s) averted. Results Post-intervention changes, relative to the control communities, in GPs’ prescribing rate trends in the experimental communities significantly increased for acamprosate ( β = 0.24, 95% CI: 0.13–0.35, p < 0.001), and significantly decreased for naltrexone ( β = −0.12, 95% CI: −0.17 to −0.06) per quarter. Quarterly hospitalisation trend rates for alcohol dependence, as principal diagnosis, significantly decreased ( β = −0.07, 95% CI: −0.13 to −0.01, p < 0.05), compared to control communities. The median ICER per quarterly hospitalisation(s) averted due to intervention was Dominant (Dominant – $12,750). Conclusion Postal, tailored feedback to GPs on their prescribing of acamprosate and naltrexone for alcohol dependence was a cost-effective intervention, in rural communities of NSW, to increase the overall prescribing of pharmacotherapies with a plausible effect on incidence reduction of hospitalisations for alcohol dependence as principal diagnosis.