dc.contributor.advisor | Lima Serrano, Marta | es |
dc.contributor.advisor | Trapero Bertrán, Marta | es |
dc.creator | Vargas Martínez, Ana Magdalena | es |
dc.date.accessioned | 2020-11-04T08:01:04Z | |
dc.date.available | 2020-11-04T08:01:04Z | |
dc.date.issued | 2020-10-02 | |
dc.identifier.citation | Vargas Martínez, A.M. (2020). Cost-effectiveness and cost-utility. Analysis of a web-based computer-tailored Programme for prevention of binge drinking in Adolescents: alerta alcohol project. (Tesis Doctoral Inédita). Universidad de Sevilla, Sevilla. | |
dc.identifier.uri | https://hdl.handle.net/11441/102433 | |
dc.description.abstract | Background: Alcohol abuse has been recognized as a global public health concern with high
prevalence among adolescents, which has numerous health, social, and economic
repercussions. In light of the need for prioritization and allocation of resources for public
health interventions, the aim of this thesis is to assess the efficiency of Alerta Alcohol, a webbased
computer-tailored intervention for the prevention of binge drinking (BD) among
adolescents. To achieve this aim, the context surrounding adolescent drinking was examined
and an analysis of the impact of binge drinking was carried out. The social, economic, and
family factors associated with BD were explored, and a comparison was made between the
health effects produced by the Alerta Alcohol programme as measured by health-related
quality of life (HRQoL) and by reduction in excessive alcohol use.
Methods: The study population consisted of adolescents aged 15 to 19 years enrolled in public
high schools in Andalusia, Spain. The sample was part of a two-arm cluster randomized
controlled trial, with an intervention group who received the Alerta Alcohol programme and
a control group who did not receive any active intervention. Longitudinal analyses were
carried out to address the objectives proposed using econometric procedures (negative
binomial, two-part model, finite mixture model, and generalized estimating equations
approach). For the economic evaluation, a decision tree analysis was used to estimate costs
and health outcomes, and incremental cost-effectiveness and cost-utility ratios were
calculated from the Spanish National Health Service (NHS) and societal perspectives.
Uncertainty was dealt through a multivariate deterministic sensitivity analysis of best/worst
scenarios by subgroups.
Results: A total of 1,247 adolescents in the pre-intervention period and 612 in the four-month
follow-up period formed the sample. In relation to socioeconomic and family factors
associated with BD, being 17 years old or older and having more weekly pocket money and
a higher family alcohol consumption frequency were associated with greater BD among
adolescents. Additionally, higher adherence to the Alerta Alcohol programme was associated
with a BD reduction at the four-month follow-up and with an increase in HRQoL, although
this last effect was very small. Subjects who reduced their number of BD occasions reported
higher perceived HRQoL. Based on the economic evaluation, the intervention was shown to be dominant from the societal perspective using both cost per BD occasion per month
averted and cost per QALY gained as outcome measures. It could also be cost-effective,
depending on willingness to pay from the NHS perspective. In addition, subgroup analyses
found a greater efficiency for girls and older adolescents (aged 17 years or older) of both
sexes.
Conclusions: The findings in relation to social, family and economic factors associated with
BD in adolescence could supplement prevention policies aimed at reducing the weekly
pocket money or economic means available to adolescents, given the association between
this variable and increased BD, and policies aimed at involving families in these interventions,
given the influence of family alcohol consumption on this pattern of alcohol consumption.
This type of programme based on computer-tailored feedback could be a cost-effective way
to reduce and prevent BD and to increase QALYs in young people, but long-term followup
would be needed to capture the full extent of the changes and effects of the programme,
after introducing some improvements in the form of the intervention and the context in
which it is carried out and after ensuring greater involvement of families. | es |
dc.format | application/pdf | es |
dc.format.extent | 197 | es |
dc.language.iso | eng | es |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 Internacional | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
dc.title | Cost-effectiveness and cost-utility. Analysis of a web-based computer-tailored Programme for prevention of binge drinking in Adolescents: alerta alcohol project | es |
dc.type | info:eu-repo/semantics/doctoralThesis | es |
dcterms.identifier | https://ror.org/03yxnpp24 | |
dc.type.version | info:eu-repo/semantics/publishedVersion | es |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Enfermería | es |
dc.publication.endPage | 197 | es |