Re: Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial
Findings can offer value for money to commissioners of alcohol services.
We read with keen interest the core finding of the study by Kaner et al that screening followed by feedback and the provision of written materials can be an effective intervention for addressing alcohol related problems.
While it would support evidence-based outcome considerations, the findings would have significant implications for commissioners in planning large-scale programmes for harmful drinkers. Our experience in addressing problematic drinking in a rural county (with around 165,000 and 28,000 people estimated as hazardous/harmful and dependent drinkers respectively) has presented a broad range of financial and practical challenges.
Our current payment of an average unit costs of about £100 per patient for extended brief interventions to specialist service providers has been financially prohibitive and with very limited demonstrable outcomes.
This findings therefore offers a feasible alternative that can be implemented responsively, possibly via GP consultations. The less intensive option of using specialist services for all patients and its associated complication for several referral pathways and high attrition rates is indeed attractive to commissioners in achieving value for money in alcohol investments. Not only would outcomes be better for the greater number of patients but there is also the potential for efficiencies and cost savings. Assuming unit costs could be agreed with primary care in the region similar to the DES payment (£2.38 - £3/screen), a programme aiming to deliver an intervention to 50,000 people using this model could potentially bring about efficiencies and cost savings in the region of £400,000 - £450,000 when compared with the NICE unit costs estimates of £11.50 for nurse led brief advice sessions.
While primary care is potentially a more cost effective option, capacity restrictions and variable interest and willingness to deliver such interventions in some practices has limited our ambition to implement similar evidence-based approaches to significant numbers of patients. We will however explore with interest these findings as an opportunity to complement our more intensive interventions for harmful drinkers.
Competing interests: No competing interests