The Cost-Effectiveness of Alcohol Interventions

Healthcare systems and funding agencies often use cost-effectiveness data to make resource-allocation decisions about which treatment options to offer patients. Two recent reviews illustrated different approaches to cost-effectiveness analysis as applied to alcohol interventions.

In the first study, researchers used computer simulation models and published data from alcohol intervention trials to estimate the incremental cost-effectiveness (CE) ratio (i.e., dollars* needed for each quality-adjusted life-year [QALY] gained) of several approaches to treating problem drinking and alcohol dependence.

• Various brief interventions for problem drinking yielded CE ratios of $62 to $505 per QALY (compared with no intervention).
• Motivation enhancement therapy (MET), which focuses on motivation and commitment to change, yielded CE ratios of $1613 to $2531 per QALY (compared with an initial assessment, feedback, and education).
• Naltrexone plus counseling for severe alcohol dependence yielded a CE ratio of $9750 per QALY (compared with placebo plus counseling).

In the second study, researchers performed a cost-effectiveness analysis within a randomized clinical trial of MET (n=347) versus social behavior and network therapy (n=261) for alcohol problems. They collected data on treatment costs,** health and societal resources use, and QALYs.

• The more expensive social behavior and network therapy yielded the same number of QALYs as did MET.
• Social behavior and network therapy cost $331 on average and yielded a net reduction in resource use of $1195 whereas MET cost $193 on average and yielded a net reduction of $888.

Comments:

In the first study, the CE ratios for most interventions studied were well below what purchasers of healthcare commonly pay to treat other diseases (e.g., $50,000 to $100,000 per QALY). In the second study, the social behavior and network therapy program was more expensive, but no more effective, than was MET. Regardless, both therapies saved about 5 times as much in health and societal resources use as they cost to deliver.

Reference:

Mortimer D, Segal L. Economic evaluation of interventions for problem drinking and alcohol dependence: cost per QALY estimates. Alcohol Alcohol. 2005;40(6):549–555.

UKATT Research Team. Cost effectiveness of treatment for alcohol problems: findings of the randomized UK alcohol treatment trial (UKATT). BMJ. 2005;331(7516):544.