This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Implementing a two week in- and day-patient regime in the treatment of patients with alcohol problems. The programme had a cognitive behavioural orientation.

Treatment.

Cost-effectiveness analysis.

Patients with an ICD 10 (World Health Organization, 1992) diagnosis of Alcohol Dependence Syndrome.

Hospital. The economic study was carried out in the UK.

Effectiveness and resource use data corresponded to patients admitted to the addiction unit programme between 1992 and 1994. The fiscal year was not explicitly specified.

Effectiveness data were derived from a single study.

Costing was prospectively performed on the same patient sample as that used in the effectiveness analysis.

Power calculations were not used to determine the sample size. The study sample consisted of 212 consecutive patients with a mean (SD) age of 45 (10.7) years, of whom the first 112 participated in the 5-week inpatient programme and the succeeding 100 underwent the 2-week in- and day-patient programme. For the sake of comparison, 75 patients in the 5-week programme were matched with 75 subjects in the 2-week programme. The participation rate of patients was 95.9%. One independent researcher gathered the data which were analysed by two experts blinded to the treatment modalities.

This was a nonrandomised study with historical controls, carried out in a single centre. The duration of the follow-up was until 1 year after discharge. At 1-year follow up, the loss to follow-up was 10.8%. Patients lost to follow-up were found not to differ significantly from the original sample.

The analysis of effectiveness was based on treatment completers only. The clinical measures used in the analysis were global measures and indices of drinking behaviour. The global outcome measures were abstinent, non-problem drinker, drinking but improved, and unimproved. The specific indices of drinking behaviour consisted of available days abstinent, intensity of drinking (units per day), alcohol-related life problems (range: 0-18), and Severity of Alcohol Dependence (SADQ) score (range: 0-60). The categorisation of the patients was based on using data from self-report (Comprehensive Drinking Profile: Follow-up Drinkers Profile: SADQ score, collateral report (Collateral Interview Form) and blood test serum-gamma-glutamyl-transpeptidase (GGT) and the mean cell volume (MCV)). The patients in the two programmes (n=75 in each programme) were matched in terms of age, gender, and dependency (SADQ scores) at baseline.

The proportion of study patients categorised as abstinent at 1 year was 36%, non-problem drinker at 1 year was 19.6%, drinking but improved at 1 year was 20.6%, and unimproved at 1 year was 23.8%.

The corresponding values for the 75 matched patients in the 5-week programme were abstinent at 1 year 34.7%, non-problem drinker at 1 year 21.3%, drinking but improved at 1 year 20%, and unimproved at 1 year 24.0%.

The corresponding values for the 2-week programme were abstinent at 1 year 37.3%, non-problem drinker at 1 year 16%, drinking but improved at 1 year 21.3%, and unimproved at 1 year 25.3%.

The differences between the groups were not found to be significant (Mann-Whitney U=2750.5, p=0.81).

In terms of indices of drinking behaviour, the overall mean (SD) values at baseline and at 1-year follow-up were as follows:

available days abstinent at baseline 4.73% (17.87) versus 68.72% (39.12) at 1 year follow-up,

intensity of drinking at baseline 18.77 (11.72) units per day versus 8.84 (10.77) units per day at 1 year follow-up,

alcohol-related life problems (range: 0-18) at baseline 6.11 (2.88) versus 1.73 (2.97) at 1 year follow-up,

SADQ score (range: 0-60) at baseline 23.66 (9.83) versus 9.56 (12.90) at 1 year follow-up.

The corresponding values for the 75 matched patients in the 2-week programme at 1 year were:

available days abstinent 70.58% (37.52),

intensity of drinking 8.04 (10.98) units per day,

alcohol related life problems (range: 0-18) 1.01 (2.02),

SADQ score (range: 0-60) 8.83 (11.60).

The corresponding values for the 75 matched patients in the 5-week programme at 1 year were:

available days abstinent 63.79% (40.74),

intensity of drinking 9.89 (10.73) units per day,

alcohol related life problems (range: 0-18) 1.80 (2.98),

SADQ score (range: 0-60) 10.36 (13.95).

The differences between the groups were not found to be significant.

The overall results at 12 months, (55.6% abstinent or non-problem drinking with only 23% unimproved), compares favourably with the results from other follow-up studies of residential treatment.

No summary benefit measure was identified in the economic analysis and only separate clinical outcomes were reported.

Costs were not discounted because of the 1 year duration of follow-up. Quantities of inpatient and/or outpatient days were reported separately from the costs. Cost items were not reported separately. The cost analysis covered the costs of inpatient and/or outpatient days, and follow-up sessions. The perspective adopted in the cost analysis was that of NHS or medical insurance. The resource use data were based on actual data from the study. The cost data were based on cost per day. The date to which the price data referred was not explicitly specified.

Not considered.

UK pounds sterling ().

Not conducted.

Not applicable.

It was only reported that the 2-week programme had a 33% lower mean cost of care compared to the 5-week regime. The corresponding value for the cost of follow-up treatment was 30.1%.

Costs and benefits were not combined since the implementation of the 2-week programme was the dominant strategy (with equal efficacy and lower costs).

A two week in- and day-patient treatment was more cost effective than a 5-week inpatient treatment.

A justification was given for the choice of the comparator. It was the typical programme in use at the time of the study in the study institution. You, as a database user, should consider whether this is a widely used health technology in your own setting.

The internal validity of the effectiveness results can not be reasonably guaranteed due to possible sampling bias, (as the authors themselves acknowledged). As both strategies were found to have similar effectiveness the study may be regarded as a cost-minimisation analysis.

Insufficient details were provided about the costing methods used in the analysis, and it is difficult to judge whether all relevant costs have been considered. Costs and quantities were not reported and only the percentage change was reported.

Given the lack of randomization, sensitivity analysis, and statistical analysis of the costs, the results should be treated with some caution. The issue of generalisability to other settings or countries was not addressed, although, appropriate comparisons were made with other studies.

Design limitations make the study conclusions tentative pending a randomized controlled trial.

None stated.