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      Cost-effectiveness of a combined classroom curriculum and parental intervention: economic evaluation of data from the Steps Towards Alcohol Misuse Prevention Programme cluster randomised controlled trial

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          Abstract

          Objectives

          This study aimed to assess the cost-effectiveness of the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) compared with education as normal (EAN) in reducing self-reported heavy episodic drinking (HED) in adolescents.

          Design

          This is a cost-effectiveness analysis from a public sector perspective conducted as part of a cluster randomised trial.

          Setting

          This study was conducted in 105 high schools in Northern Ireland and in Scotland.

          Participants

          Students in school year 8/S1 (aged 11–12) at baseline were included in the study.

          Interventions

          This is a classroom-based alcohol education curricula, combined with a brief alcohol intervention for parents/carers.

          Outcome measures

          The outcome of this study is the cost per young person experiencing HED avoided due to STAMPP at 33 months from baseline.

          Results

          The total cost of STAMPP was £85 900, equivalent to £818 per school and £15 per pupil. Due to very low uptake of the parental component, we calculated costs of £692 per school and £13 per pupil without this element. Costs per pupil were reduced further to £426 per school and £8 per pupil when it was assumed there were no additional costs of classroom delivery if STAMPP was delivered as part of activities such as personal, social, health and economic education. STAMPP was associated with a significantly greater proportion of pupils experiencing a heavy drinking episode avoided (0.08/8%) and slightly lower public sector costs (mean difference −£17.19). At a notional willingness-to-pay threshold of £15 (reflecting the cost of STAMPP), the probability of STAMPP being cost-effective was 56%. This level of uncertainty reflected the substantial variability in the cost differences between groups.

          Conclusions

          STAMPP was relatively low cost and reduced HED. STAMPP was not associated with any clear public sector cost savings, but neither did it increase them or lead to any cost-shifting within the public sector categories. Further research is required to establish if the cost-effectiveness of STAMPP is sustained in the long term.

          Trial registration number

          ISRCTN47028486; Results.

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          Most cited references20

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          A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective.

          Clive Henn, Robyn Burton, Nick Sheron … (2017)
          This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.
          Article 0 comments Cited 129 times – based on 0 reviews     Review now
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            Is it important to prevent early exposure to drugs and alcohol among adolescents?

            Richie Poulton, W Slutske, Candice Odgers … (2008)
            Exposure to alcohol and illicit drugs during early adolescence has been associated with poor outcomes in adulthood. However, many adolescents with exposure to these substances also have a history of conduct problems, which raises the question of whether early exposure to alcohol and drugs leads to poor outcomes only for those adolescents who are already at risk. In a 30-year prospective study, we tested whether there was evidence that early substance exposure can be a causal factor for adolescents' future lives. After propensity-score matching, early-exposed adolescents remained at an increased risk for a number of poor outcomes. Approximately 50% of adolescents exposed to alcohol and illicit drugs prior to age 15 had no conduct-problem history, yet were still at an increased risk for adult substance dependence, herpes infection, early pregnancy, and crime. Efforts to reduce or delay early substance exposure may prevent a wide range of adult health problems and should not be restricted to adolescents who are already at risk.
            Article 0 comments Cited 62 times – based on 0 reviews     Review now
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              Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP).

              Fiona Farringdon, Richard Midford, Lynn B Meuleners … (2004)
              The School Health and Alcohol Harm Reduction Project (SHAHRP study) aimed to reduce alcohol-related harm in secondary school students. The study used a quasi-experimental research design in which randomly selected and allocated intervention and comparison groups were assessed at eight, 20 and 32 months after baseline. Metropolitan, government secondary schools in Perth, Western Australia. The sample involved over 2300 students. The retention rate was 75.9% over 32 months. The evidence-based intervention, a curriculum programme with an explicit harm minimization goal, was conducted in two phases over a 2-year period. Knowledge, attitude, total alcohol consumption, risky consumption, context of use, harm associated with own use and harm associated with other people's use of alcohol. There were significant knowledge, attitude and behavioural effects early in the study, some of which were maintained for the duration of the study. The intervention group had significantly greater knowledge during the programme phases, and significantly safer alcohol-related attitudes to final follow-up, but both scores were converging by 32 months. Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students. During the first and second programme phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences were converging 17 months after programme delivery. Intervention students were 25.7%, 33.8% and 4.2% less likely to drink to risky levels from first follow-up onwards. The intervention reduced the harm that young people reported associated with their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards. There was no impact on the harm that students reported from other people's use of alcohol. The results of this study support the use of harm reduction goals and classroom approaches in school drug education.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2019
                Publication date (Electronic): 2 July 2019
                Volume: 9
                Issue: 7
                Electronic Location Identifier: e027951
                Affiliations
                [1 ] departmentNorthern Ireland Clinical Trials Unit , The Royal Hospitals , Belfast, UK
                [2 ] departmentDepartment of Psychological Sciences , University of Liverpool School of Life Sciences , Liverpool, UK
                [3 ] departmentPsychology and Public Health , Oxford Brookes University , Oxford, UK
                [4 ] departmentSchool of Sport, Health and Exercise Sciences , University of Bangor , Bangor, UK
                [5 ] departmentSchool of Social Sciences, Education and Social Work , Queen’s University Belfast , Belfast, UK
                [6 ] departmentPublic Health Institute , Liverpool John Moores University , Liverpool, UK
                Author notes
                [Correspondence to ] Dr Ashley Agus; ashley.agus@ 123456nictu.hscni.net
                Author information
                http://orcid.org/0000-0001-9839-6282
                http://orcid.org/0000-0001-9752-7527
                Article
                Publisher ID: bmjopen-2018-027951
                DOI: 10.1136/bmjopen-2018-027951
                PMC ID: 6609141
                PubMed ID: 31270116
                SO-VID: 45c3bd97-4af0-4a38-9381-5f9814e90582
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 15 November 2018
                Date revision received : 30 April 2019
                Date accepted : 07 June 2019
                Categories
                Subject: Health Economics
                Subject: Research
                Subject: 1506
                Subject: 1701
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: public health,health economics,community child health,alcohol misuse,school-based
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: public health, health economics, community child health, alcohol misuse, school-based

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