A Literature Review of Cost-Benefit Analyses for the Treatment of Alcohol Dependence

Article (PDF Available)inInternational Journal of Environmental Research and Public Health 8(8):3351-64 · August 2011with70 Reads
DOI: 10.3390/ijerph8083351 · Source: PubMed
Abstract
The purpose of this study was to conduct a literature review of cost-benefit studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD). A literature search was performed in multiple electronic bibliographic databases. The search identified seven psychotherapy studies from the USA and two pharmacotherapy studies from Europe. In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.
Int. J. Environ. Res. Public Health 2011, 8, 3351-3364; doi:10.3390/ijerph8083351
International Journal of
Environmental Research and
Public Health
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Review
A Literature Review of Cost-Benefit Analyses for the Treatment
of Alcohol Dependence
Svetlana Popova
1,2,3,
*, Satya Mohapatra
1
, Jayadeep Patra
1,2
, Amy Duhig
4
and
Jürgen Rehm
1,2,5
1
Social and Epidemiological Research Department, Centre for Addiction and Mental Health,
33 Russell St., Toronto, Ontario M5S 2S1, Canada; E-Mails: satyacamh@gmail.com (S.M.);
jaydeep.patra@gmail.com (J.P.); jtrehm@aol.com (J.R.)
2
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario
M5T 3M7, Canada
3
Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto,
Ontario M5S 1V4, Canada
4
Eli Lilly and Company, Global Health Outcomes, Indianapolis, IN 46285, USA;
E-Mail: amduhig@gmail.com
5
Klinische Psychologie und Psychotherapie, Epidemiological Research Unit, Technische Universität,
Hohe Street 53, Dresden D-01187, Germany
* Author to whom correspondence should be addressed; E-Mail: lana_popova@camh.net;
Tel.: +1-416-535-8501; Fax: +1-416-260-4156.
Received: 7 June 2011; in revised form: 3 August 2011 / Accepted: 3 August 2011 /
Published: 16 August 2011
Abstract: The purpose of this study was to conduct a literature review of cost-benefit
studies on pharmacotherapy and psychotherapy treatments of alcohol dependence (AD).
A literature search was performed in multiple electronic bibliographic databases. The
search identified seven psychotherapy studies from the USA and two pharmacotherapy
studies from Europe. In the psychotherapy studies, major benefits are typically seen within
the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0.
Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 €) per
patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was
estimated to be Pta. 3,914,680 (23,528 €). To date, only a few studies exist that have
OPEN ACCESS
Int. J. Environ. Res. Public Health 2011, 8
3352
examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of
the available treatment options for AD appear to produce marked economic benefits.
Keywords: alcohol dependence treatment; psychotherapy; pharmacotherapy; costs; benefits
1. Introduction
There are many types of treatment for alcohol dependence (AD), including psychosocial support
groups such as Alcoholics Anonymous, inpatient and outpatient treatment, psychological interventions,
pharmacological treatment, employee assistance programs (EAPs) and most typically, a combination
of the aforementioned [1,2]. Most psychosocial interventions (e.g., cognitive behavioural therapy,
motivational enhancement therapy) focus on helping patients decrease the frequency of alcohol use,
and also address issues that have maintained their drinking behaviours such as familial, social, and
work-related dynamics [3-5]. Psychosocial intervention formats are either one-on-one individual
counselling or group counseling.
Pertaining to pharmacotherapies, the U.S. Food and Drug Administration (FDA) has approved four
pharmacologic agents for the treatment of AD to date: disulfiram, oral naltrexone, injectable
long-acting naltrexone, and acamprosate. The European Medicines Agency has not yet approved
long-acting naltrexone.
Disulfiram, an aversive agent, has been used to treat AD for more than 50 years; however, the
evidence for its effectiveness is weak. It has significant adverse effects and there is not sufficient
evidence that it increases abstinence rates, decreases relapse rates, or reduces cravings [6]. Per the
FDA, oral Naltrexone is indicated in the treatment of AD in combination with an appropriate plan of
management for alcohol addiction. Over 20 clinical trials, as well as meta-analytic reviews support a
modest effect of oral naltrexone, and support its effect on reducing heavy drinking, increasing abstinence
rates and decreasing alcohol cravings in a number of study populations (e.g., [7-9]). Long-acting
injectable naltrexone is indicated for the treatment of AD in conjunction with psychosocial support for
patients who are abstinent at treatment initiation. Reductions in the number of drinking days and heavy
drinking days have been reported; similar to oral Naltrexone, the effects are small [10].
In contrast to naltrexone, acamprosate is indicated for the maintenance of abstinence from
alcohol in patients who are abstinent from consuming alcohol and who are simultaneously engaged
in psychosocial support. Recent reviews of acamprosate in clinical trials suggest that the medication
is primarily effective in extending continuous abstinence (e.g., [8,11]). Some other medications,
although not approved by the U.S. FDA for the treatment of AD, have some support for their efficacy,
such as anticonvulsants (e.g., gabapentin, topiramate [12], baclofen [13],), serotonergic agents
(e.g., sertraline [14,15], ondansetron [12]), and glutamatergic agents (e.g., mementine; [6,16]).
To date, there are only a few studies that have examined the costs/benefits of psychotherapy or
pharmacotherapy treatment of AD (see for example, [17]
)
. A Cost-Benefit Analysis (CBA) incorporates
multiple outcome measures to gain a more comprehensive picture of the total economic impact of the
AD treatment. This analysis allows valuing of all outcomes of treatment in monetary terms so that the
net economic benefits or a benefit-cost ratio, both of which enable the comparison of different
Int. J. Environ. Res. Public Health 2011, 8
3353
treatment options, can be obtained. The purpose of the current study was to conduct a search of the
current literature in order to determine the available evidence of cost-benefit analyses on
pharmacotherapy and psychotherapy AD treatments.
2. Materials and Methods
2.1. Literature Search
A literature search for studies that have conducted a CBA on the social costs/benefits attributable to
AD treatment was performed in multiple electronic bibliographic databases from January 1995 to
January 2011, including: Ovid MEDLINE, PubMed, EMBASE, Web of Science, and PsychINFO.
Google Scholar, the Cochrane Database of Systematic Reviews and economic databases, such as
Centre for Review and Dissemination (CRD) (http://www.crd.york.ac.uk/crdweb/) were also searched.
The search was conducted using multiple combinations of the following key words: alcohol, alcoholism,
cost, dependence, treatment, pharmacotherapy, psychotherapy, psychosocial treatment, cost-benefit
analysis, and economic evaluation. The search was not limited to English language publications or to
any geographic area.
2.2. Data Extraction
Three investigators (S.M., J.P., and S.P.) independently extracted information from the identified
studies. Training of coders to achieve sufficient (>0.80) interrater reliability (IRR) was conducted.
IRR, a statistical measure for the degree of agreement among raters that gives a score of how much
homogeneity, or consensus there is in the ratings given by different raters, was calculated by Fleiss’
kappa statistics using the attribute agreement analytic method. Discrepancies were reconciled by a
fourth investigator (JR) independent of the first process. All analyses related to IRR were computed
using Minitab statistical software [18]. Using a standardized spreadsheet (MS-Excel), each study
was coded for the following variables: reference, country where the study was completed, sample size,
type of intervention, types of cost, types of benefits, and benefit-cost ratio.
3. Results
In total, 94 articles were identified. After reviewing these articles, 61 articles were retained that
included economic evaluations of alcohol treatment. Upon further screening for studies involving CBA
of AD treatment, the data were extracted from nine articles providing original studies on the
cost-benefit of AD treatment: seven psychotherapy studies from USA and two pharmacotherapy
studies from Europe (one each from Belgium and Spain). A flow diagram describing the search
strategy is presented in Figure 1.
Int. J. Environ. Res. Public Health 2011, 8
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Figure 1. Flow diagram describing the search strategy for cost-benefit studies of alcohol
dependence treatment.
There was a high IRR (j = 0.81, P < 0.0001) among the three reviewers across all variables coded.
Table 1 provides the type of intervention and cost descriptions for the identified studies. The net
benefits and/or benefit-cost ratios are presented in Table 2.
94 Computer assisted + manual search
Key words: alcohol, alcoholism, cost, dependence, treatment,
pharmacotherapy, psychotherapy, psychosocial treatment, cost-benefit
analysis,
and
economic evaluation
.
33 articles excluded from the
study: no data on economic
38 articles excluded from the
study: not involving cost-benefit
analysis of AD treatment
23
studies selected for review
13 articles excluded from the study:
not involving original cost-benefit
analysis of AD treatment
9 studies selected for data extraction:
7 Psychotherapy studies
2 Pharmacotherap
y studies
61 studies identified for further screening
for cost-benefit analysis of AD treatment
Int. J. Environ. Res. Public Health 2011, 8
3355
Table 1. Summary of cost-benefit studies on alcohol dependence treatment.
Reference
Country
Population & Sample Size Type of Intervention Type of Cost
PSYCHOTHERAPY
[19] USA
36 newly abstinent married
male alcoholics
1. IC
2. IC + BMT
3. IC + ICT & 24 month follow-up
Average costs:
IC $450;
IC + BMT $857
IC + ICT $895
[20] USA
59 couples with a newly
abstinent alcoholic husband
1. BMT
2. BMT + RP
Average costs:
BMT $864,
BMT + RP $1,640
[21] USA 482 M & 292 W, age 18–65
BI by physicians & 12 month follow-up;
Review of the prevalence of problem drinking,
PT specific alcohol effects, worksheet on
drinking cues, drinking agreement as a
prescription & drinking diary cards
$205 per PT
(clinic cost $165.65, PT cost
$38.97)
[22] USA 482 M & 292 W, age 18–65
BI by physicians & 48 month follow-up;
Review of normative drinking, PT specific
alcohol effects, worksheet on drinking cues,
drinking diary cards, drinking agreement as a
prescription
$205 per PT
(clinic cost $166, PT cost
$39)
[23] USA 105 M & 53 W, age 65+
Brief intervention by physicians & 24-month
follow-up assessment, feedback, contracting
& goal-setting
$236 per PT
(clinic cost $197, PT cost
$39)
Int. J. Environ. Res. Public Health 2011, 8
3356
Table 1. Cont.
Reference
Country
Population & Sample Size Type of Intervention Type of Cost
[24] USA Primary care clinics BI by physicians: 12- & 48-month follow-up
$205 per PT
(Screening & assessment
$88, training cost $23,
intervention cost $55, PT
cost $39)
[25] USA
Injured PT treated in an
emergency department or
admitted to a hospital (6%
of 20,507,601 adult PTs
treated for injuries)
Screening + BI
Direct injury-
related medical
costs (screening + BI) $600
per PT
PHARMACOTHERAPY
[26] Belgium 448 alcoholic PT
12-month treatment with acamprosate &
12-month follow-up
Per-PT cost:
No treatment 5,783
€;
Acamprosate 5,255 €
[27] Spain
Total alcohol-dependent PT
population in Spain
(approximately 627,400)
Treatment with acamprosate for 1 year,
time horizon for benefit was 11–16 years
Spain Pta 42,
430 million per
year if 50% of affected PT
received treatment
(Pta 33,944 million if 40%
received treatment &
Pta 50,917 million if 60%
received treatment)
BI: Brief Intervention; BMT: Behavioural Marital Therapy; IC: Individual Counselling; ICT: Interactional Couples Therapy: PT: Patient(s);
RP: Relapse Prevention; M: Men; W: Women.
Int. J. Environ. Res. Public Health 2011, 8
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Table 2. Net benefit or cost-benefit ratio for alcohol dependence treatment.
Reference
Country Net Benefits Benefit-cost Ratio
PSYCHOTHERAPY
[19] USA Average benefits: IC, $7,581;
IC + BMT, $6,681;
IC + ICT, (−)$2,248
IC, 20.77
IC + BMT, 8.64
IC + ICT, (−)$2.82
[20] USA Average benefits: BMT, $5,053;
BMT + RP, $3,365
BMT, 5.97,
BMT + RP, 1.89
[21] USA $1,151 per PT
Savings: Medical $523, Legal cost & MVE $629
3.2 Medical,
5.6 Societal
[22] USA $7,985 per PT
Savings: Medical $712, Legal cost $102, MVE $7,171
4.3 Medical,
39.0 Societal
[23] USA $5,241 per PT
Savings: Medical $3,260, MVE $1,613, Life-years lost $368,
Other social consequences $1,981
NA
[24] USA $7,985 per PT
Savings: Medical $712, Legal cost $102, MVE $7,171
4.3 Medical,
39.0 Societal
[25] USA $89 for each PT screened; $330 for each PT offered BI 3.81 Medical
PHARMACOTHERAPY
[26] Belgium Per PT acamprosate-attributable net cost-savings:
€ 528 over 2 years
NA
[27] Spain Lifetime benefit for each PT, Pta 3,914,680;
avoidance of indirect costs & nonspecific direct costs, Pta
3,409,349; avoidance of direct health-related benefits, Pta 505,331
NA
BI: Brief Intervention; BMT: Behavioural Marital Therapy; IC: Individual Counselling; ICT: Interactional
Couples Therapy; MVE: Motor Vehicle Event; NA: Not Available; PT: Patient(s); RP: Relapse Prevention.
3.1. Psychotherapy Studies
In a study in Massachusetts, USA [20] involving 36 newly abstinent married male alcoholics, the
patients were divided into three groups for outpatient treatment, namely: (1) Individual counselling;
(2) Individual counselling plus behavioural marital therapy (BMT); and (3) Individual counselling plus
interactional couples therapy (ICT) with a 24-month follow-up. It was observed that both individual
counselling alone and in combination with BMT showed substantial and significant cost savings from
reduced utilization of healthcare and legal systems that substantially and significantly exceeded the
cost of delivering the treatment. Individual counselling alone had a higher benefit-cost ratio (20.77)
than BMT plus individual counselling (8.64) due to the lower cost of delivering the treatment.
Individual counselling plus ICT had a negative benefit-cost ratio of (−2.82) due to the high cost
of treatment.
Another study by the above research group [20] involving 59 couples with a newly abstinent
alcoholic husband, estimated the cost-benefit of BMT with or without relapse prevention (RP) sessions
for alcoholics and their spouses. Both standard BMT and for the longer and more costly form of BMT
with the additional RP sessions showed (a) decreases in health care and legal costs after, as compared
to before, treatment; (b) positive cost offsets (or savings); and (c) benefit-cost ratios greater than 1,
indicating that health and legal system cost savings (i.e., benefits) exceeded the costs of delivering the
Int. J. Environ. Res. Public Health 2011, 8
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BMT treatments. In fact, cost savings from reduced utilization were more than 5 times greater than the
cost of delivering the standard 5- to 6-month BMT program. Although adding RP to BMT led to less
drinking and better marital adjustment, it did not lead to greater cost savings in health and legal service
utilization. The benefit-cost ratio for BMT was 5.97 compared to 1.89 for BMT with RP.
Two cost-benefit analyses [21,22] involving brief interventions by physicians through review of the
prevalence of problem drinking, patient specific alcohol effects, worksheet on drinking cues, drinking
agreement in the form of a prescription and drinking diary cards for 482 men and 292 women (age
18–65) in Wisconsin, USA, exhibited positive net benefits for patients, the healthcare system as well
as society. The intervention, conducted by physicians, included two 15-minute face-to-face counselling
sessions one month apart and two 5-minute nurse follow-up phone contacts. The average number of
drinks and binge drinking episodes declined at the 6-month follow-up point. Although it declined
further during 12–48 month follow-up, the major effect occurred within six months of the intervention.
The benefit-cost analysis was performed from two different perspectives: (1) the medical care system
perspective, which considered costs to the medical care system and benefits from reductions in future
emergency room visits and hospitalizations; and (2) the societal perspective, which considered all costs
and benefits to the clinic, patient, and society in general. The benefit-cost ratios were 3.2 and 4.3 for
the medical system, and the societal benefit-cost ratios were 5.6 and 39.0 after 12 and 48 months of
treatment, respectively.
Mundt and colleagues [23] examined older adults (105 men and 53 women, aged 65 and older) who
received a brief intervention by a physician through assessment, feedback, contracting and goal setting.
Results indicated a 40% decrease in average weekly alcohol consumption compared to 6% in the
control group in 3-month follow-up and maintained significantly lower levels of alcohol consumption
and heavy episodic drinking throughout a 24-month observation period. Monetary benefits of $5,241
per patient ($3,260 in healthcare and motor vehicle events: $1,613, life-years lost: $368, and other
social consequences: $1,981) were observed for the treatment group as compared to the control group.
In a study of injured patients treated in an emergency department or admitted to a hospital in the
USA, Gentilello and colleagues [25] analyzed direct injury-related medical costs and cost-benefits due
to screening and brief intervention. It was found that if the brief intervention was offered, the expected
cost of screening, intervention, and subsequent emergency department visits and hospital admissions
over the next three years was $600 per patient. In the scenario where screening and intervention were
not offered, the expected cost of subsequent emergency department visits and hospital admissions was
$689 per patient over three years, resulting in an estimated cost savings of $89 per injured patient
screened, or $330 for each patient offered a brief intervention. The brief intervention resulted in $3.81
in health care costs saved for every $1.00 spent on screening and intervention.
3.2. Pharmacotherapy Studies
In a study [26] involving 448 alcoholic patients in Belgium, 12-month treatment with acamprosate
and 12-month follow-up resulted in net cost savings of 21,301 BEF (528 €) per patient over a
24-month period for acamprosate treatment compared to placebo (Figure 2), due to a fewer acute
hospitalizations for detoxification, less liver complications and less institutionalized rehabilitation.
Int. J. Environ. Res. Public Health 2011, 8
3359
Figure 2. Distribution of costs (in Euros) for acamprosate versus no treatment in the
Belgian study [26].
860
84 84
1,960
3,279
438
5,255
2,654
1,208
439
5,784
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2,000
3,000
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It was estimated that treatment with acamprosate would have an anticipated saving of 70 million
BEF (1.74 million Euro) over a two year period, for Belgium. Although this study provided a good
estimate of the healthcare costs, there were some limitations. For instance, cost-benefits to the legal
system or due to productivity losses were not determined. Also, the cost data were derived from the
Belgian health care system, whereas the clinical data come from an Austrian study in which abstinence
rates were considerably lower than other European studies [28].
In a study by Portella et al. [27] involving the total alcohol-dependent patient population in Spain
(estimated to be approximately 627,400 people), it was calculated that treatment of AD (including
hospitalization, physician visits, rehabilitation and medication) for the population would cost Spain
Pta 42,430 million per year if 50% of AD patients received treatment (Pta 33,944 million if 40%
received treatment and Pta 50,917 million if 60% received treatment). The total lifetime benefit for
each rehabilitated patient, without any subsequent alcohol-related complications was calculated to be
Pta 3,914,680 (23,528 €). The net benefit for the population if 50% of patients were treated under the
best-case scenario (29.1% of treated patients become rehabilitated, 25% of rehabilitated patients
develop complications) was Pta 303,953 million, and under the worst case scenario (10% of
treated patients become rehabilitated, 75% of rehabilitated patients develop complications) was
Pta 68,484 million. Varying the percentage of the patient population that would be treated between 40
and 60% produced net benefit ranges between Pta 364,743 million for the best case scenario and
Pta 54,87 million for the worst case scenario.
This study has some limitations. While estimating the total lifetime benefit for each rehabilitated
patient, it was assumed that there would be no subsequent alcohol-related complications. Again, most
of the benefit was attributable to avoidance of indirect costs and non-specific direct
costs (Pta 3,409,349), whereas direct health-related benefits were substantially less (Pta 05,331).
Int. J. Environ. Res. Public Health 2011, 8
3360
4. Conclusions
Treatment of alcoholism is associated with a decrease in total health care utilization [29,30] and
thus, produces marked economic benefits for most of the treatment options. A present analysis of
studies, concerning cost-benefit attributable to AD treatment, revealed that most of the treatment
options produce marked economic benefits with the benefit-cost ratio ranging from 1.89 to 39.00. The
highest benefit-cost ratios were observed in brief intervention studies [21,22].
All studies involving psychotherapy treatments have reported that major cost-benefits have been
achieved in the first six months. The benefits to the healthcare system as well as the society as a whole,
of course, continue to increase with time. While in most of the studies, individual counselling and
behavioural therapy are quite effective and accrue significant economic benefits, some treatment
procedures like interactional couples therapy have resulted in negative benefit-cost ratios due to the
high cost of treatment. In addition, it has to be noted that the participants in brief intervention studies
included in this analysis [21-24] might not all be alcohol dependent but rather exhibit alcohol abuse.
Although there are relatively more cost-benefit studies on psychotherapy treatments of AD, only
two studies were identified that had included a CBA of pharmacotherapy for the treatment of AD.
These two cost-benefit studies on pharmacotherapy of AD were related to acamprosate; there were no
cost benefit study involving oral or injectable naltrexone, disulfiram or any other drug. Nonetheless, it
is important to note from these few available studies that pharmacotherapy treatment of AD accrues
economic benefits to the healthcare system as well as to society.
It is important to note that the considerations for benefit-calculations have been different in the
reviewed studies. While in some cases, the societal benefits included benefits to the health care system
and the legal system; some other studies included savings in other indirect societal costs such as
productivity losses.
Reduction of binge drinking/heavy drinking occasions (both regular and irregular) and its
associated problems is of overriding importance. A dichotomous criterion of abstinence does not
differentiate sufficiently, and is unrealistic, as many have a drink/relapse at one time or another. The
reduction of heavy drinking occasions is a key for (a) health outcomes, and also for (b) criminality
outcomes. The highest benefit in classical cost-benefit studies will, of course, be achieved if both
dimensions are combined, and disability is included in the health outcomes.
Studies on the economic aspects of AD treatment and psychiatric co-morbidity are scarce, although
there are a number of studies that demonstrate the efficacy of pharmacotherapy of individuals with AD
and co-morbid psychiatric illness [31]. However, the main question here is causality. The main
problem is to identify the portion of co-morbidity, which is due to AD. Co-morbidity may be caused
by AD, by the other condition, or by a third variable influencing both. We seem to have no way to
disentangle these mechanisms. One way to deal with this would be to look into health service
utilization, especially in mental institutions, before and after pharmacotherapy of alcohol
dependence - e.g., a design where service utilization is measured in the two years before and the two
years after treatment and the costs are compared.
The vast majority of identified economic analyses were cost analyses, often mislabeled as
“cost-benefit analyses”. The reviewed studies usually compared the costs associated with treatment
with the accompanying (economic) savings and estimated net costs (or savings). However, these
Int. J. Environ. Res. Public Health 2011, 8
3361
studies commonly fail to estimate the indirect economic benefit of health effects (i.e., decreases in
mortality and improvements in quality of life).
Any new study on AD psychotherapy or pharmacotherapy should include a cost-benefit component.
Cost-benefits should be evaluated with the inclusion of all major cost components. Other types of
economic components that need to be included are cost-effectiveness (CE) and cost-utility (CU). In CE
analysis, the incremental cost of a program from a particular viewpoint is related to the incremental
health effects of the program measured in “natural units” such as a symptom score or symptom-free
days. The results are expressed as cost per unit of effect in these units. CE components should be
measured with the key outcomes (i.e., amount of heavy drinking occasions). In CU analysis,
the incremental cost of a program from a particular viewpoint is compared to the incremental
health improvement attributable to that program, where the health improvement is measured in
quality-adjusted life-years (QALY) gained. Both CE and CU should cover a longer time period
(5–10 years), compared to the usual analyses of 6 to 12 months. A new study should thus include a
short-term and a long-term component.
Future economic evaluation studies should compare psychotherapy, pharmacotherapy or adjuvant
treatments involving combined medications. There is also a need for an intensive study of the
interactive effects of a number of combinations of medication other than naltrexone and acamprosate
and psychosocial treatment [32].
Any new well-conducted economic study could help define the field further with respect to what
should be the standard psychosocial treatment in addition to pharmacotherapy. Adjunctive psychosocial
treatment with close follow-up is advisable for AD pharmacotherapy treatment [33]. The strengths of
these psychosocial treatment alternatives to enhance medication adherence, preventing attrition,
addressing co-morbid problems, fostering abstinence, and targeting the weaknesses of the pharmacologic
agent, as well as the characteristics of the target population need to be considered while choosing the
type of psychosocial treatment [34].
Future studies also need to consider potential “side effects of treatment” (i.e., subjects may decrease
their consumption of alcohol with a treatment, but increase their use of other substances). There is a
need to examine the economic effects of AD treatment on other psychiatric disorders, especially if
there are compounds that may have positive effects on both AD and psychiatric co-morbid disorders.
Acknowledgments
The authors wish to acknowledge the financial assistance for this study from Eli Lilly and
Company, Indianapolis, USA. In addition, support to the Centre for Addiction and Mental Health for
the salaries of scientists and infrastructure has been provided by the Ontario Ministry of Health and
Long-Term Care. The views expressed in this manuscript do not necessarily reflect those of the
Ontario Ministry of Health and Long-Term Care.
Int. J. Environ. Res. Public Health 2011, 8
3362
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    • "It provides benefits both to the drinker and to those around them. Treatment of alcohol dependence is also estimated to save governments money, with a benefit : cost ratio of 1.9–39.0:1.0 [5]. However, health professionals and Indigenous communities have often advised of the unmet demand for alcohol treatment services and the difficulties Indigenous Australians face in accessing these. "
    [Show abstract] [Hide abstract] ABSTRACT: Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need. In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need. Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
    Article · Aug 2015
    • "Die Inanspruchnahme von Hilfe scheint jedoch in allen betrachteten soziodemografischen Bevçlkerungsgruppen gleichermaßen gering zu sein. Um die Versorgungsrate zu erhçhen und dadurch substanzbedingte Mortalität und Kosten zu senken (Holder, 1998; Popova et al., 2011; Rehm, Shield, Rehm, Gmel & Frick, 2012), bedarf es weiterer Forschung zu fçrderlichen und hemmenden Faktoren der Inanspruchnahme professioneller Hilfe. "
    [Show abstract] [Hide abstract] ABSTRACT: Zusammenfassung: Ziel: Es wurden 12-Monats-Prävalenzen geschätzt bezüglich a) der Wahrnehmung substanzbezogener Probleme, b) der Inanspruchnahme verschiedener Hilfsangebote und c) der Inanspruchnahme professioneller Hilfe. Faktoren, die mit der Inanspruchnahme von Hilfe assoziiert sind, wurden analysiert. Methodik: Die Auswertung basiert auf Daten des Epidemiologischen Suchtsurveys (ESA) 2012 (n = 9084; 18 – 64 Jahre; Ausschöpfungsrate 53.6 %). Missbrauch und Abhängigkeit nach DSM-IV wurden anhand des M-CIDI erfasst. Prädiktoren der Hilfesuche wurden regressionsanalytisch getestet. Ergebnisse: Zwischen 6 % (Alkohol) und 19 % (illegale Drogen) der Konsumenten berichteten substanzbezogene Probleme. Von diesen nahmen 14 % (Alkohol), 33 % (Illegale Drogen) bzw. 59 % (Medikamente) Hilfe in Anspruch. Mit Ausnahme des Einkommens bei Alkoholkonsumenten waren soziodemografische Variablen nicht mit der Inanspruchnahme von Hilfe assoziiert. Schlussfolgerungen: Die Studie zeigt eine Unterversorgung von Personen mit substanzbezogenen Problemen. Das Hilfesuchverhalten scheint hauptsächlich durch die Schwere der substanzbezogenen Störung beeinflusst zu sein. Abstract: Aims: It was aimed to estimate 12-months prevalences of a) perception of substance-related problems among alcohol, illicit drugs and prescription drug users; b) use of several formal and informal sources of care by individuals perceiving substance-related problems; and iii) use of professional help among individuals with a substance use disorder. Factors associated with help-seeking were assessed. Methods: Data come from the 2012 Epidemiological Survey of Substance Abuse (ESA; n = 9084; 18 to 64 years; response rate 53.6 %). DSM-IV diagnoses were assessed using the M-CIDI. Regression analyses were used to assess predictors of help-seeking. Results: Between 6% (alcohol) and 19 % (illicit drugs) of substance users reported having experienced substance related problems. Of those, 14 % (alcohol), 33 % (illicit drugs) and 59 % (prescription drugs) sought help. With the exception of income, socio-demographic variables were not associated with help-seeking. Conclusions: Results show a clear under-treatment in individuals with substance related problems. Helpseeking seems to be mainly influenced by the severity of the substance-related disorder.
    Full-text · Article · Dec 2013
    • "Treating ARDs may lead to a decrease in total health care utilization, thus producing significant economic benefits. Although only a few studies have examined specifically the cost–benefit of psychosocial and pharmacological interventions for ARDs, especially for alcohol dependence, most of the available treatment options produce marked economic benefits, as recently reviewed by Popova et al. (2011). Experience from Australia (Cobiac et al., 2009), the USA (Zarkin et al., 2010) and other countries (Tariq et al., 2009; Moraes et al., 2010) show that alcohol treatments can lead to long-term social benefits, including reduced costs associated with health care, arrests, and motor vehicle accidents. "
    [Show abstract] [Hide abstract] ABSTRACT: Alcohol-related disorders (ARDs) have become an increasing mental health and social challenge in China. Research from China may provide important clinical information for researchers and clinicians around the world. However, most of the Chinese research on ARDs has only been published in Chinese language journals. This article summarizes publications related to treatments for ARDs found in the Chinese literature. A descriptive study based on literature identified from searches of the China National Knowledge Infrastructure (1979-2012), Pubmed databases and hand-picked references with emphasis on traditional Chinese medicine (TCM). More than 1500 Chinese language papers on treatment for ARDs were found and ~110 were selected. Many medications used in the Western countries (e.g. disulfiram and acamprosate) are not available in China, and no drugs have been officially approved for alcohol dependence. TCM approaches (including acupuncture, electroacupunture and herbals) have played a role in treatment for ARDs with some positive results. These unique methods are reviewed and the need for additional controlled studies is noted. Currently, very limited facilities, medications or programs are available for patients with ARDs in China, thus much improvement is needed in the field, including setting up intervention/treatment programs.
    Full-text · Article · Jun 2012
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