Aims
The ai
ms of this study were to conduct a rando
mised controlled trial to evaluate the cost-effectiveness of tailored, postal feedback on general practitioners¡¯ (GPs) prescribing of aca
mprosate and naltrexone for alcohol dependence relative to current practice and its i
mpact on alcohol dependence
morbidity.
Methods
Rural communities in New South Wales, Australia, were randomised into experimental (m>Nm> = 10) and control (m>Nm> = 10) communities. Tailored feedback on their prescribing of alcohol pharmacotherapies was mailed to GPs from the experimental communities (m>Nm> = 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 (m>¦Âm> = 0.24, 95 % CI: 0.13-0.35, m>pm> < 0.001), and significantly decreased for naltrexone (m>¦Âm> = ?0.12, 95 % CI: ?0.17 to ?0.06) per quarter. Quarterly hospitalisation trend rates for alcohol dependence, as principal diagnosis, significantly decreased (m>¦Âm> = ?0.07, 95 % CI: ?0.13 to ?0.01, m>pm> < 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.