JMIR Publications

ABSTRACT

Background:

Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general wellbeing of cancer survivors.

Objective:

To evaluate the effectiveness, cost-effectiveness and cost-utility of a digital interactive AM intervention compared to a non-interactive online information brochure for cancer survivors, in a pragmatic randomised controlled trial.

Methods:

A health economic evaluation alongside a pragmatic two-arm parallel-group randomised controlled trial (RCT) was conducted with baseline assessment and follow-ups at 3, 6 and 12 months post-randomisation comparing the AM intervention with the information brochure. The study was conducted online in The Netherlands, from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch recommended drinking guidelines (maximum 7 standard units [10g alcohol] per week) with the intention to moderate or quit drinking. In total, 103 participants were randomised and analysed; 53 in the MyCourse group and 50 in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention “MyCourse – Moderate Drinking”. The primary outcome was self-reported number of standard drinks (10 gr of ethanol) in the past 7 days at 6-month follow-up. Secondary outcome measures were alcohol-related problems as measured by the AUDIT and treatment satisfaction at all follow-ups. For the health economic evaluation, healthcare costs, costs due to productivity losses and intervention costs were assessed over a 12-month horizon.

Results:

Alcohol use at 6-month follow-up declined by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between groups (B = 2.1, 95%CI −7.6 to 3.1, P = .22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between groups (Cohen’s d = 0.3, 95%CI −0.1 to 0.6, P = .21). Intervention costs were estimated at US$ 279 per participant for the MyCourse group and at US$ 74 for the control group, mean societal costs were US$ 18,092 (MyCourse) and US$ 23,496 (control). The MyCourse group led to fewer gained QALYs, at lower societal costs in the cost-utility analysis. In the cost-effectiveness analysis, the MyCourse group led to a larger reduction in drinking units over time at lower societal costs (incremental cost-effectiveness ratio per reduced drink US$ −1,158, 95% CI −1,609 to −781).

Conclusions:

At 6 months, alcohol use was reduced by about a third in both groups, with no significant differences between the digital interactive intervention MyCourse and a non-interactive online brochure. At 12 months, cost-effectiveness analyses showed that MyCourse led to a larger reduction in drinking units over time, at lower societal costs. The MyCourse group led to marginally fewer gained QALYs, also at lower societal costs. Clinical Trial: The trial was prospectively registered in The Netherlands Trial Register (NTR): NTR6010, https://www.trialregister.nl/trial/5433 on 1 September 2016.