Evaluaciones económicas de intervenciones dirigidas a la prevención, tratamiento y/o rehabilitación de trastornos por consumo de alcohol: una revisión sistemática

Marta Trapero-Bertran, Dolors Gil-Doménech, Ana Magdalena Vargas-Martínez

Resumen


El objetivo de esta revisión sistemática de la literatura es identificar evaluaciones económicas de programas o intervenciones dirigidas a la prevención, tratamiento y rehabilitación de trastornos por consumo de alcohol, así como determinar aquellos tipos de programas, tratamientos o intervenciones que son eficientes. Se realizó una revisión sistemática de la literatura mediante la búsqueda en las siguientes bases de datos: National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), MEDLINE Ovid and PubMed. Los términos de búsqueda utilizados fueron en inglés. No se aplicó ninguna restricción de tiempo. Se utilizó un formulario de extracción de datos para resumir la información. La revisión sistemática siguió las recomendaciones (PRISMA-P) sobre la presentación de informes de revisiones sistemáticas. Las intervenciones fueron clasificadas en tres categorías: «A» tratamientos para personas con trastornos por consumo de alcohol (prevención terciaria); «B» tratamientos para personas en riesgo de problemas relacionados con el alcohol (prevención secundaria); «C» legislación sobre políticas e intervenciones de aplicación (prevención terciaria). Además, las intervenciones «A» fueron subclasificadas en intervenciones psicológicas, farmacológicas y combinadas. Se incluyeron 63 documentos. En términos de tratamientos para personas con trastornos por uso de alcohol, cualquier intervención psicosocial en comparación con ninguna intervención parece ser una estrategia dominante. En términos de tratamientos para personas en riesgo de problemas relacionados con el alcohol, la intervención breve parece ser dominante o rentable en comparación con no hacer nada. Los controles publicitarios, las subidas de impuestos, las licencias, la edad legal para consumir alcohol y las campañas en los medios de comunicación parecen ser una estrategia dominante o rentable en comparación con ninguna intervención o prueba aleatoria de alcoholemia. Se han ampliado las revisiones anteriores al mostrar los programas de alcohol según criterios de eficiencia. A pesar de ello, los estudios disponibles al respecto tienen enfoques heterogéneos y la mayoría no define adecuadamente los costes incluidos en su análisis. Por tanto, es necesario continuar evaluando en términos de eficiencia este tipo de intervenciones para informar mejor la toma de decisiones en salud pública.


Palabras clave


Alcohol; revisión sistemática; eficiencia; coste-efectividad; clasificación intervenciones

Texto completo:

PDF PDF (English)

Referencias


Alwyn, T., John, B., Hodgson, R. J. y Phillips, C. J. (2004). The addition of a psychological intervention to a home detoxification programme. Alcohol and Alcoholism, 39, 536–541. doi:10.1093/alcalc/agh092.

Angus, C., Latimer, N., Preston, L., Li, J. y Purshouse, R. (2014). What are the implications for policy makers? A systematic review of the cost-effectiveness of screening and brief interventions for alcohol misuse in primary care. Frontiers in Psychiatry, 5, 114. doi:10.3389/fpsyt.2014.00114.

Avanceña, A., Miller, N., Uttal, S. E., Hutton, D. W. y Mellinger, J. L. (2020). Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis. Journal of hepatology. Advance publication online. doi:10.1016/j.jhep.2020.12.004.

Babor, T. F., Higgins-Biddle, J. C., Dauder, D., Burleson, J. a., Zarkin, G. a. y Bray, J. (2006). Brief interventions for at-risk drinking: Patient outcomes and cost-effectiveness in managed care organizations. Alcohol and Alcoholism, 41, 624–631. doi: 10.1093/alcalc/agl078.

Barbosa, C., Cowell, A., Bray, J., y Aldridge, A. (2015). The cost-effectiveness of alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in emergency and outpatient medical settings. Journal of Substance Abuse Treatment, 53, 1–8. doi:10.1016/j.jsat.2015.01.003.

Barbosa, C., Cowell, A., Dowd, W., Landwehr, J., Aldridge, A., y Bray, J. (2017). The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States. Addiction, 112 (Supl. 2), 73–81. doi:10.1111/add.13658.

Barbosa, C., Godfrey, C. y Parrott, S. (2010). Methodological assessment of economic evaluations of alcohol treatment: What is missing? Alcohol and Alcoholism, 45, 53–63. doi:10.1093/alcalc/agp067.

Bischof, G., Grothues, J. M., Reinhardt, S., Meyer, C., John, U. y Rumpf, H. J. (2008). Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: A randomized controlled trial. Drug and Alcohol Dependence, 93, 244–251. doi:10.1016/j.drugalcdep.2007.10.003.

Bray, J. W., Zarkin, G. A., Hinde, J. M. y Mills, M. J. (2012). Costs of alcohol screening and brief intervention in medical settings: a review of the literature. Journal of Studies on Alcohol and Drugs, 73, 911–919. doi:10.15288/jsad.2012.73.911.

Brodtkorb, T-H., Bell, M., Irving, A.H. y Laramée, P. (2016). The cost effectiveness of nalmefene for reduction of alcohol consumption in alcohol-dependent patients with high or very high drinking-risk levels from a UK societal perspective. CNS Drugs, 30, 163-177. doi:10.1007/s40263-016-0310-2.

Brown, T. J., Todd, A., O’Malley, C. L., Moore, H. J., Husband, A. K., Bambra, C.,… Summerbell, C. D. (2016). Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. BMJ Open, 6, e009828. doi:10.1136/bmjopen-2015-009828.

Burke, T. R. (1988). The economic impact of alcohol abuse and alcoholism. Public Health Reports, 103, 564–568.

Chisholm, D., Doran, C., Shibuya, K. y Rehm, J. (2006). Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug and Alcohol Review, 25, 553–565. doi:10.1080/09595230600944487.

Chisholm, D., Moro, D., Bertram, M., Pretorius, C., Gmel, G., Shield, K. y Rehm, J. (2018). Are the “best buys” for alcohol control still valid? An update on the comparative cost-effectiveness of alcohol control strategies at the global level. Journal of Studies on Alcohol and Drugs, 79, 514–522.

Chisholm, D., Rehm, J., Van Ommeren, M. y Monteiro, M. (2004). Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. Journal of Studies on Alcohol, 65, 782–793. doi: 10.15288/jsa.2004.65.782.

Cobiac, L., Vos, T., Doran, C. y Wallace, A. (2009). Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction, 104, 1646–1655. doi:10.1111/j.1360-0443.2009.02708.x.

Donaldson, C., Mugford, M. y Vale, L. (Eds.). (2002). Evidence-based health economics: from effectiveness to efficiency in systematic review. London: BMJ Publishing Group.

Drummond, M., Sculpher, M., Claxton, K., Stoddard, G. L. y Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes (4th ed.). United Kingdom: Oxford University Press.

Drummond, M., Weatherly, H., Claxton, K., Cookson, R., Ferguson, B., Godfrey, C. y Rice, N. (2007). Assessing the challenges of applying standard methods of economic evaluation to public health interventions (2nd ed.). York: Public Health Research Consortium.

Dunlap, L. J., O’Farrell, T. J., Schumm, J. A., Orme, S. S., Murphy, M. y Murchowski, P. M. (2020). Group versus standard behavioral couples’ therapy for alcohol use disorder patients: Cost-effectiveness. Journal of Studies on Alcohol and Drugs, 81, 152–163. doi:10.15288/jsad.2020.81.152.

Dunlap, L. J., Zarkin, G. A., Bray, J. W., Mills, M., Kivlahan, D. R., McKay, J. R.,… Tonigan, J. S. (2010). Revisiting the cost-effectiveness of the COMBINE study for alcohol dependent patients: The patient perspective. Medical Care, 48, 306–313. doi:10.1097/mlr.0b013e3181ca3d40.

Falcón, M., Navarro-Zaragoza, J., García-Rodríguez, R. M., Nova-López, D., González-Navarro, M. D., Mercadal, M.,… Luna Ruiz-Cabello, A. (2018). Perceived barriers to implementing screening and brief intervention for alcohol consumption by adolescents in hospital emergency department in Spain. Adicciones, 30, 189-196. doi:10.20882/adicciones.896.

Frías-Torres, C., Moreno-España, J., Ortega, L., Barrio, P., Gual, A. y Teixidor López, L. (2018). Remediation therapy in patients with alcohol use disorders and neurocognitive disorders: A Pilot Study. Adicciones, 30, 93-100. doi:10.20882/adicciones.757.

Goeree, R. y Diaby, V. (2013). Introduction to health economics and decision-making: Is economics relevant for the frontline clinician? Best Practice and Research: Clinical Gastroenterology, 27, 831–844. doi: 10.1016/j.bpg.2013.08.016.

Gold, M. R., Siegel, J. E., Russell, L. B. y Weinstein, M. C. (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.

Hill, S. R., Vale, L., Hunter, D., Henderson, E. y Oluboyede, Y. (2017). Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges. Health Policy, 121, 1249–1262. doi:10.1016/j.healthpol.2017.10.003.

Hoang, V. P., Shanahan, M., Shukla, N., Perez, P., Farrell, M. y Ritter, A. (2016). A systematic review of modelling approaches in economic evaluations of health interventions for drug and alcohol problems. BMC Health Services Research, 16, 127. doi: 10.1186/s12913-016-1368-8.

Holmes, J., Meng, Y., Meier, P. S., Brennan, A., Angus, C., Campbell-Burton, A., … Purshouse, R.C. (2014). Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. Lancet, 383, 1655–64. doi:10.1016/S0140-6736(13)62417-4.

Humphreys, K. y Moos, R. (1996). Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services, 47, 709–713. doi:10.1176/ps.47.7.709.

Kaner, E. F., Beyer, F. R., Garnett, C., Crane, D., Brown, J., Muirhead, C.,… Michie, S. (2017). Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database of Systematic Reviews, 9, CD011479. doi:10.1002/14651858.CD011479.pub2.

Kelly, J. F., Abry, A., Ferri, M. y Humphreys, K. (2020). Alcoholics anonymous and 12-step facilitation treatments for alcohol use disorder: A distillation of a 2020 Cochrane review for clinicians and policy makers. Alcohol and Alcoholism, 55, 641-651. doi:10.1093/alcalc/agaa050.

Kernick, D. P. (2003). Introduction to health economics for the medical practitioner. Postgraduate Medical Journal, 79, 147–150. doi:10.1136/pmj.79.929.147.

Kruse, C. S., Lee, K., Watson, J. B., Lobo, L. G., Stoppelmoor, A. G. y Oyibo, S. E. (2020). Measures of effectiveness, efficiency, and quality of telemedicine in the management of alcohol abuse, addiction, and rehabilitation: Systematic review. Journal of Medical Internet Research, 22, e13252. doi: 10.2196/13252.

Laramée, P., Bell, M., Irving, A., y Brodtkorb, T. H. (2016). The Cost-effectiveness of the integration of nalmefene within the UK healthcare system treatment pathway for alcohol dependence. Alcohol and Alcoholism, 51, 283–290. doi:10.1093/alcalc/agv140.

Laramée, P., Brodtkorb, T.-H., Rahhali, N., Knight, C., Barbosa, C., Francois,… Rehm, J. (2014). The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: A Markov model. BMJ Open, 4, e005376. doi:10.1136/bmjopen-2014-005376.

Lock, C. A., Kaner, E., Heather, N., Doughty, J., Crawshaw, A., McNamee, P.,… Pearson, P. (2006). Effectiveness of nurse-led brief alcohol intervention: A cluster randomized controlled trial. Journal of Advanced Nursing, 54, 426–439. doi:10.1111/j.1365-2648.2006.03836.x.

Long, C., Williams, M. y Hollin, C. (1998). Treating alcohol problems: A study of programme effectiveness and cost effectiveness according to length and delivery of treatment. Addiction, 93, 561–571. doi:10.1046/j.1360-0443.1998.93456111.x

Lonsdale, A. J., Hardcastle, S. J. y Hagger, M. S. (2012). A minimum price per unit of alcohol: a focus group study to investigate public opinion concerning UK government proposals to introduce new price controls to curb alcohol consumption. BMC Public Health, 12, 1023. doi:10.1186/1471-2458-12-1023.

Ludbrook, A. (2004). Effective and cost-effective measures to reduce alcohol misuse in Scotland: an update. Edinburgh: Scottish Executive Health Department.

Ludbrook, A., Godfrey, C., Wyness, L., Parrott, S., Haw, S., Napper, M. y van Teijlingen, E. (2002). Effective and cost-effective measures to reduce alcohol misuse in Scotland: a literature review. Edinburgh: Scottish Executive Health Department.

Meads, C., Ting, S., Dretzke, J. y Bayliss, S. (2007). A systematic review of the clinical and cost-effectiveness of psychological therapy involving family and friends in alcohol misuse or dependence. Report Number 65. Birmingham, Department of Public Health and Epidemiology, West Midlands Health Technology Assessment Collaboration …

Millier, A., Laramée, P., Rahhali, N., Aballéa, S., Daeppen, J. B., Rehm, J., y Toumi, M. (2017). Cost-effectiveness of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: A microsimulation model. Journal of Studies on Alcohol and Drugs, 78, 867–876. doi:10.15288/jsad.2017.78.867.

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M.,… the PRISMA-P Group (2015). Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4, 1. doi:10.1186/2046-4053-4-1.

Mujoomdar, M. y Spry, C. (2009). Naltrexone for the treatment of alcohol dependence: a review of the clinical and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH).. Recuperado de https://www.cadth.ca/sites/default/files/pdf/L0076_Naltrexone_for_alcohol_dependence.pdf.

Nalpas, B., Combescure, C., Pierre, B., Ledent, T., Gillet, C., Playoust, D.,… Daurès, J. P . (2003). Financial costs of alcoholism treatment programs: a longitudinal and comparative evaluation among four specialized centers. Alcoholism, Clinical and Experimental Research, 27, 51–56. doi:10.1097/01.ALC.0000047301.72437.10.

Ndegwa, S. y Cunningham, J. (2009). Naltrexone in combination with acamprosate for the treatment of alcohol dependence: a review of the clinical and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Recuperado de https://www.cadth.ca/media/pdf/L0123_Naltrexone_and_Acamprosate_final.pdf.

Pettinati, H. M., Meyers, K., Evans, B. D., Ruetsch, C. R., Kaplan, F. N., Jensen, J. M. y Hadley, T. R. (1999). Inpatient alcohol treatment in a private healthcare setting: Which patients benefit and at what cost? American Journal on Addictions, 8, 220–233. doi:10.1080/105504999305839.

Poldrugo, F., Haeger, D. A., Comte, S., Walburg, J. y Palmer, A. J. (2005). A critical review of pharmacoeconomic studies of acamprosate. Alcohol and Alcoholism, 40, 422–430. doi:10.1093/alcalc/agh171.

Purshouse, R. C., Meier, P. S., Brennan, A., Taylor, K. B. y Rafia, R. (2010). Estimated effect of alcohol pricing policies on health and health economic outcomes in England: An epidemiological model. Lancet, 375, 1355–64. doi:10.1016/S0140-6736(10)60058-X.

Rehm, J. y Barbosa, C. (2018). The cost-effectiveness of therapies to treat alcohol use disorders. Expert review of Pharmacoeconomics & Outcomes Research18, 43–49. doi:10.1080/14737167.2018.1392241.

Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y. y Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223-2233. doi:10.1016/S0140-6736(09)60746-7.

Shakeshaft, A. P., Bowman, J. A., Burrows, S., Doran, C. M. y Sanson-Fisher, R. W. (2002). Community-based alcohol counselling: A randomized clinical trial. Addiction, 97, 1449–1463. doi:10.1046/j.1360-0443.2002.00199.x.

Slattery, J., Chick, J., Cochrane, M., Craig, J., Godfrey, C., Macpherson, K. y Parrot, S. (2002). Health Technology Assessment of Prevention of Relapse in Alcohol Dependence. Consultation Assessment Report. Scotland: Health Technology Board for Scotland. Recuperado de https://www.drugsandalcohol.ie/19424/1/Health_Technology_Assessment_Prevention_of_relapse_in_alcohol_dependence.pdf.

Sloan, F. A. y Hsieh, C.-R. (2012). Health Economics. United States of America: The Massachusetts Institute of Technology (MIT) Press.

Smyth, A., Teo, K. K., Rangarajan, S., O’Donnell, M., Zhang, X., Rana, P.,… PURE Investigators (2015). Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet, 6736, 1–10.. doi:10.1016/S0140-6736(15)00235-4.

Sobell, L. C., Sobell, M. B., Leo, G. I., Agrawal, S., Johnson-Young, L. y Cunningh am, J. A. (2002). Promoting self-change with alcohol abusers: a community-level mail intervention based on natural recovery studies. Alcoholism: Clinical and Experimental Research, 26, 936–948.

The Joanna Briggs Institute (JBI) (2014). Joanna Briggs Institute for Evidence Based Practice Reviewers’ manual 2014. The Systematic Review of Economic Evaluation Evidence. Australia, The Joanna Briggs Institute, The University of Adelaide. Recuperado de https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Economic.pdf.

White, P., Skirrow, H., George, A. y Memon, A. (2018). A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom. Journal of Public Health, 40, e521–e530. doi:10.1093/pubmed/fdy026.

Williams, I., McIver, S., Moore, D. y Bryan, S. (2008). The use of economic evaluations in NHS decision-making: A review and empirical investigation. Health Technology Assessment, 12, 1-175. doi:10.3310/hta12070.

Organización Mundial de la Salud. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva, Organización Mundial de la Salud.

Organización Mundial de la Salud (2018). Global status report on alcohol and health 2018. Geneva, Organización Mundial de la Salud.

Yadav, R.-P. y Kobayashi, M. (2015). A systematic review : Effectiveness of mass media campaigns for reducing drink-driving and alcohol-related crashes. BMC Public Health, 15, 857. doi:10.1016/j.amepre.2004.03.002.




DOI: https://doi.org/10.20882/adicciones.1649

Enlaces refback

  • No hay ningún enlace refback.