Interventions:
The selection of comparators was appropriate and might also be applicable to other settings. The ALCMOD is used for analysis of eHealth interventions in several countries.
Effectiveness/benefits:
Clinical data were retrieved from selectively identified sources that appeared generally appropriate. Treatment effect was taken from clinical trials and meta-analyses of clinical trials that should provide high internal validity. Epidemiological data were taken from local large databases and reflect the Dutch population. Clinical data were varied in the stochastic simulation.
DALYs are an appropriate benefit measure as the disease affects both survival and disability conditions. Specifically, the model focused on the impact of the interventions on health-related quality of life because mortality was not a relevant dimension of health given the short term of the analysis.
Costs:
The economic analysis was carried out satisfactorily but was restricted to the costs of programme implementation. Details of unit costs and quantities of resources used were presented clearly, which increased the transparency of the economic side of the study. The assessment of costs followed strict guidelines for calculation of costs within the Dutch health care system. Quantities of resource use were taken directly from the implementation of the systems in the authors’ setting. Costs of reducing the risk of alcohol-related diseases were not considered given the short-term time horizon of the analysis. The authors acknowledged that costs of programme implementation were not considered and the real cost of each programme might be higher. The reference year was reported and this enabled reflation exercises in other time periods. Cost estimates were subjected to uncertainty analysis.
Analysis and results:
Study results were presented clearly. An incremental analysis was appropriately performed to synthesise costs and benefits of the alternative strategies. The financial return of the investment was reported. The authors highlighted the advantages and disadvantages of the ALCMOD. A stochastic analysis was appropriately used to investigate the issue of uncertainty and results were presented clearly by means of cost-effectiveness acceptability curves. The authors stated that the study findings could not be transferred in other settings since the availability and use of the Internet varied among countries and population segments.
Concluding remarks:
The analysis used a valid and transparent methodology that enhances the robustness of the authors’ conclusions.