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Cost-effectiveness of a combined classroom curriculum and parental intervention: economic evaluation of data from the Steps Towards Alcohol Misuse Prevention Programme cluster randomised controlled trial
  1. Ashley Agus1,
  2. Michael McKay2,
  3. Jonathan Cole2,
  4. Paul Doherty1,
  5. David Foxcroft3,
  6. Séamus Harvey4,
  7. Lynn Murphy1,
  8. Andrew Percy5,
  9. Harry Sumnall6
  1. 1 Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
  2. 2 Department of Psychological Sciences, University of Liverpool School of Life Sciences, Liverpool, UK
  3. 3 Psychology and Public Health, Oxford Brookes University, Oxford, UK
  4. 4 School of Sport, Health and Exercise Sciences, University of Bangor, Bangor, UK
  5. 5 School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
  6. 6 Public Health Institute, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Dr Ashley Agus; ashley.agus{at}


Objectives This study aimed to assess the cost-effectiveness of the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) compared with education as normal (EAN) in reducing self-reported heavy episodic drinking (HED) in adolescents.

Design This is a cost-effectiveness analysis from a public sector perspective conducted as part of a cluster randomised trial.

Setting This study was conducted in 105 high schools in Northern Ireland and in Scotland.

Participants Students in school year 8/S1 (aged 11–12) at baseline were included in the study.

Interventions This is a classroom-based alcohol education curricula, combined with a brief alcohol intervention for parents/carers.

Outcome measures The outcome of this study is the cost per young person experiencing HED avoided due to STAMPP at 33 months from baseline.

Results The total cost of STAMPP was £85 900, equivalent to £818 per school and £15 per pupil. Due to very low uptake of the parental component, we calculated costs of £692 per school and £13 per pupil without this element. Costs per pupil were reduced further to £426 per school and £8 per pupil when it was assumed there were no additional costs of classroom delivery if STAMPP was delivered as part of activities such as personal, social, health and economic education. STAMPP was associated with a significantly greater proportion of pupils experiencing a heavy drinking episode avoided (0.08/8%) and slightly lower public sector costs (mean difference −£17.19). At a notional willingness-to-pay threshold of £15 (reflecting the cost of STAMPP), the probability of STAMPP being cost-effective was 56%. This level of uncertainty reflected the substantial variability in the cost differences between groups.

Conclusions STAMPP was relatively low cost and reduced HED. STAMPP was not associated with any clear public sector cost savings, but neither did it increase them or lead to any cost-shifting within the public sector categories. Further research is required to establish if the cost-effectiveness of STAMPP is sustained in the long term.

Trial registration number ISRCTN47028486; Results.

  • public health
  • health economics
  • community child health
  • alcohol misuse
  • school-based

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  • Contributors HS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AA undertook the health economic analysis, wrote the first draft of the manuscript and subsequent versions, and submitted the final version; HS was project principal investigator, contributed to the first draft and subsequent iterations of the manuscript; JC, PD, DF, SH, MMcK, LM and AP all contributed to drafts and approved the submission.

  • Funding This trial was funded by the National Institute of Health Research Public Health Research programme (project number 10/3002/09). The Public Health Agency of Northern Ireland and Education Boards of Glasgow/Inverclyde provided some intervention costs. Diageo provided funds to print classroom workbooks for use only in the Glasgow Local Authority area. Remaining intervention costs were internally funded.

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute of Health Research (NIHR)-Public Health Research, NIHR, National Health Service or the Department of Health. The research and intervention funders had no involvement in intervention design; design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

  • Competing interests The sponsor University (LJMU) received and administered a payment from the alcohol industry for printing of student workbooks in the Glasgow trial site only. Percy reported that he has previously received funding from the European Foundation of Alcohol Research (ERAB) in relation to the development of statistical models for longitudinal data (2008-2010). Foxcroft reported that his department has previously received funding from the alcohol industry for unrelated prevention programme training work. Sumnall reported that his department has previously received funding from the alcohol industry (indirectly via the industry funded Drinkaware charity) for unrelated primary research.

  • Ethics approval The research was approved by Liverpool John Moores University Research Ethics Committee (11/HEA/097). Consent was obtained from school head teachers/principals before randomisation. Consent from participants and their parents/guardians was obtained after randomisation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated during and/or analysed during the current study are not yet publicly available due to the authors undertaking additional analyses and follow-on studies, but are available from the corresponding author on reasonable request.

  • Patient consent for publication Obtained.