Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study.

OBJECTIVE: The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption. METHODS: A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii). RESULTS: There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level. CONCLUSIONS: Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain.

Cost effectiveness of hepatitis A virus immunisation in Spain.

The aim of this study was to evaluate, in economic terms, the recently launched hepatitis A vaccine in comparison with the use of nonspecific immune globulin, for the prevention of hepatitis A. A cost-effectiveness analysis was performed, comparing mass and selective strategies for both active and passive immunisation in children, adolescents and the high-risk adult population. Direct costs of diagnosis, treatment and immunisation, and travelling expenses of the individuals, were considered. The alternative of mass vaccination for children and adolescents cost 2679 to 6394 European Currency Units (ECU) [$US 3040 to $US 8312; 1994 values] per case prevented. Selective vaccination of high-risk individuals cost ECU205 per case prevented for young adults (those aged about 20 years) when the annual risk of contracting the disease was 0.7%, while there were net savings for all age groups when there was a 2 to 3% risk. The most sensitive variables affecting the cost of mass-vaccination strategies were incidence of hepatitis A, vaccine coverage and vaccine cost; for the various high-risk groups, these were vaccine cost, incidence of hepatitis A and costs of treating infection. Selective vaccination, depending on the age of high-risk patients [mainly travellers to endemic areas for periods of over 6 months, or those under 'precarious' conditions (e.g. backpackers, even for short periods)], is the most efficient alternative; in fact, the cost-effectiveness ratio has not been calculated, since there were net savings. For occasional travellers (as above, and those travelling for periods of under 6 months in 10 years), passive immunisation is more efficient. Selective vaccination for package-tour, short-stay travellers (infection risk around 0.3%) and strategies for mass vaccination of children and adolescents are not justified from an efficiency point of view.