Economic evaluation of alcohol treatments: linking drinking patterns, alcohol consequences and cost effectiveness of alcohol treatments

The negative individual and social impacts of alcohol consumption raise a considerable policy interest surrounding alcohol treatment. Economic evaluations help on the allocation of scarce health care resources, but these have been inadequately conducted in the alcohol field. This thesis builds up a taxonomy of alcohol-related consequences that should be included in economic evaluations of alcohol treatment and uses this taxonomy to critically review the published evidence around the cost effectiveness of alcohol treatments. The review provides a set of recommendations and most of them are pursued throughout the thesis. An economic model for the cost effectiveness of alcohol treatments is developed. The framework provides the means to conduct economic evaluation while bearing the complexity and challenges of decision making in the field of human behaviour. A link between drinking patterns, health consequences and alcohol treatment effectiveness and cost effectiveness is created. This is a probabilistic lifetime model that uses the cohort simulation approach. The model can be applied to any setting and this is exemplified for a UK-scenario. The methods and data for the generation of UK-specific model inputs are described and used in two model applications. A first application of the model extrapolates the results of a short term randomized controlled trial and provides the expected lifetime costs and outcomes of the treatments compared, by age and gender. A second application compares two alcohol treatments delivered in different countries and to populations very different at baseline. Both case-studies show the importance of time and that only a long-term analysis can capture both short-term alcohol consequences, such as injuries, and long-term consequences, such as most forms of alcohol-related chronic diseases. Assumptions and implications of the methods and analyses are discussed and recommendations for future research are presented.