TY - JOUR
KW - Adolescent
KW - Adult
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Alcoholism/blood/diagnosis/economics
KW - Biological Markers/blood
KW - Cohort Studies
KW - Computer Simulation/economics
KW - Cost-Benefit Analysis
KW - Decision Support Techniques
KW - Decision Trees
KW - Female
KW - Humans
KW - Male
KW - Mass Screening/economics/methods
KW - Middle Aged
KW - Primary Health Care/economics/methods
KW - Prospective Studies
KW - Questionnaires/economics
KW - Review Literature as Topic
KW - Transferrin/analogs & derivatives/analysis/economics
KW - Young Adult
AU - A. Kapoor
AU - K. L. Kraemer
AU - K. J. Smith
AU - M. S. Roberts
AU - R. Saitz
A1 - 
AB - BACKGROUND: The %carbohydrate deficient transferrin (%CDT) test offers objective evidence of unhealthy alcohol use but its cost-effectiveness in primary care conditions is unknown. METHODS: Using a decision tree and Markov model, we performed a literature-based cost-effectiveness analysis of 4 strategies for detecting unhealthy alcohol use in adult primary care patients: (i) Questionnaire Only, using a validated 3-item alcohol questionnaire; (ii) %CDT Only; (iii) Questionnaire followed by %CDT (Questionnaire-%CDT) if the questionnaire is negative; and (iv) No Screening. For those patients screening positive, clinicians performed more detailed assessment to characterize unhealthy use and determine therapy. We estimated costs using Medicare reimbursement and the Medical Expenditure Panel Survey. We determined sensitivity, specificity, prevalence of disease, and mortality from the medical literature. In the base case, we calculated the incremental cost-effectiveness ratio (ICER) in 2006 dollars per quality-adjusted life year ($/QALY) for a 50-year-old cohort. RESULTS: In the base case, the ICER for the Questionnaire-%CDT strategy was $15,500/QALY compared with the Questionnaire Only strategy. Other strategies were dominated. When the prevalence of unhealthy alcohol use exceeded 15% and screening age was <60 years, the Questionnaire-%CDT strategy costs less than $50,000/QALY compared to the Questionnaire Only strategy. CONCLUSIONS: Adding %CDT to questionnaire-based screening for unhealthy alcohol use was cost-effective in our literature-based decision analytic model set in typical primary care conditions. Screening with %CDT should be considered for adults up to the age of 60 when the prevalence of unhealthy alcohol use is 15% or more and screening questionnaires are negative.
BT - Alcoholism, Clinical and Experimental Research
C5 - Financing & Sustainability
CP - 8
CY - England
DO - 10.1111/j.1530-0277.2009.00974.x
IS - 8
JF - Alcoholism, Clinical and Experimental Research
N2 - BACKGROUND: The %carbohydrate deficient transferrin (%CDT) test offers objective evidence of unhealthy alcohol use but its cost-effectiveness in primary care conditions is unknown. METHODS: Using a decision tree and Markov model, we performed a literature-based cost-effectiveness analysis of 4 strategies for detecting unhealthy alcohol use in adult primary care patients: (i) Questionnaire Only, using a validated 3-item alcohol questionnaire; (ii) %CDT Only; (iii) Questionnaire followed by %CDT (Questionnaire-%CDT) if the questionnaire is negative; and (iv) No Screening. For those patients screening positive, clinicians performed more detailed assessment to characterize unhealthy use and determine therapy. We estimated costs using Medicare reimbursement and the Medical Expenditure Panel Survey. We determined sensitivity, specificity, prevalence of disease, and mortality from the medical literature. In the base case, we calculated the incremental cost-effectiveness ratio (ICER) in 2006 dollars per quality-adjusted life year ($/QALY) for a 50-year-old cohort. RESULTS: In the base case, the ICER for the Questionnaire-%CDT strategy was $15,500/QALY compared with the Questionnaire Only strategy. Other strategies were dominated. When the prevalence of unhealthy alcohol use exceeded 15% and screening age was <60 years, the Questionnaire-%CDT strategy costs less than $50,000/QALY compared to the Questionnaire Only strategy. CONCLUSIONS: Adding %CDT to questionnaire-based screening for unhealthy alcohol use was cost-effective in our literature-based decision analytic model set in typical primary care conditions. Screening with %CDT should be considered for adults up to the age of 60 when the prevalence of unhealthy alcohol use is 15% or more and screening questionnaires are negative.
PP - England
PY - 2009
SN - 1530-0277; 0145-6008
SP - 1440
EP - 1449
EP - 
T1 - Cost-effectiveness of screening for unhealthy alcohol use with % carbohydrate deficient transferrin: Results from a literature-based decision analytic computer model
T2 - Alcoholism, Clinical and Experimental Research
TI - Cost-effectiveness of screening for unhealthy alcohol use with % carbohydrate deficient transferrin: Results from a literature-based decision analytic computer model
U1 - Financing & Sustainability
U2 - 19426168
U3 - 10.1111/j.1530-0277.2009.00974.x
VL - 33
VO - 1530-0277; 0145-6008
Y1 - 2009
ER -