original adicciones vol. xx, nº x · 2021 Economic evaluations of interventions aimed at the prevention, treatment and/or rehabilitation of alcohol-related disorders: a systematic review 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***. * Basic Sciences Department. University Institute for Patient Care. Universitat Internacional de Catalunya (UIC Barcelona). ** Faculty of Economic and Social Sciences. Universitat Internacional de Catalunya (UIC Barcelona). *** Department of Nursing. Faculty of Nursing, Physiotherapy and Podiatry. Universidad de Sevilla (US). Universitat Internacional de Catalunya (UIC Barcelona). Abstract Resumen The aim of this systematic literature review is to identify economic El objetivo de esta revisión sistemática de la literatura es identificar eva- evaluations of programmes or interventions aimed at the prevention, luaciones económicas de programas o intervenciones dirigidas a la pre- treatment and rehabilitation of alcohol use disorders, as well as to vención, tratamiento y rehabilitación de trastornos por consumo de al- determine those types of programmes, treatments or interventions cohol, así como determinar aquellos tipos de programas, tratamientos that are efficient. The systematic literature review was conducted by o intervenciones que son eficientes. Se realizó una revisión sistemática searching the following databases: National Health Service Economic de la literatura mediante la búsqueda en las siguientes bases de datos: Evaluation Database (NHS EED), Health Technology Assessment National Health Service Economic Evaluation Database (NHS EED), (HTA), MEDLINE Ovid and PubMed. The search terms used were in Health Technology Assessment (HTA), MEDLINE Ovid and PubMed. English. No time restriction was applied. A data extraction form was Los términos de búsqueda utilizados fueron en inglés. No se aplicó used to draw information. The systematic review follows the recom- ninguna restricción de tiempo. Se utilizó un formulario de extracción mendations of the Preferred Reporting Items for Systematic Review de datos para resumir la información. La revisión sistemática siguió las and Meta-Analysis Protocols (PRISMA-P) on reporting systematic recomendaciones (PRISMA-P) sobre la presentación de informes de reviews. The interventions were classified into three categories: “A” revisiones sistemáticas. Las intervenciones fueron clasificadas en tres ca- treatments for people with alcohol use disorders (tertiary preven- tegorías: «A» tratamientos para personas con trastornos por consumo tion); “B” treatments for people at risk for alcohol-related problems de alcohol (prevención terciaria); «B» tratamientos para personas en (secondary prevention); “C” policy legislation and enforcement inter- riesgo de problemas relacionados con el alcohol (prevención secun- ventions (primary prevention). Furthermore, the “A” interventions daria); «C» legislación sobre políticas e intervenciones de aplicación were subclassified into psychological, pharmacological and combined (prevención terciaria). Además, las intervenciones «A» fueron subclasi- interventions. The review included 63 papers. In terms of treatments ficadas en intervenciones psicológicas, farmacológicas y combinadas. Se for people with alcohol use disorders, any psychosocial intervention incluyeron 63 documentos. En términos de tratamientos para personas compared to no intervention appeared to be a dominant strategy. In con trastornos por uso de alcohol, cualquier intervención psicosocial terms of treatments for people at risk of alcohol-related problems, en comparación con ninguna intervención parece ser una estrategia brief intervention appears to be dominant or cost-effective when com- dominante. En términos de tratamientos para personas en riesgo de pared to no intervention. Advertising controls, tax increases, licens- problemas relacionados con el alcohol, la intervención breve parece ing, legal drinking age, and mass media campaigns seem to be dom- ser dominante o rentable en comparación con no hacer nada. Los con- inant or cost-effective strategies compared to no intervention or ran- troles publicitarios, las subidas de impuestos, las licencias, la edad legal dom breath testing. Previous reviews have been extended by depicting para consumir alcohol y las campañas en los medios de comunicación alcohol programmes according to their efficiency. Despite this, the parecen ser una estrategia dominante o rentable en comparación con available studies in this regard have heterogeneous approaches and ninguna intervención o prueba aleatoria de alcoholemia. Se han am- most do not adequately define the costs included in their analyses. pliado las revisiones anteriores al mostrar los programas de alcohol se- Therefore, it is necessary to encourage the evaluation of the efficiency gún criterios de eficiencia. A pesar de ello, los estudios disponibles al of these types of interventions to aid decision-making in public health. respecto tienen enfoques heterogéneos y la mayoría no define adecua- Key words: alcohol, systematic review, efficiency, cost-effectiveness, in- damente los costes incluidos en su análisis. Por tanto, es necesario con- tervention classification. tinuar 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, costo-efectividad, clasificación intervenciones. Received: December 2020; Accepted: March 2021. Send correspondence to: Marta Trapero-Bertran PhD. Universitat Internacional de Catalunya (UIC). Basic Sciences Department. University Institute for Patient CareCarrer de Josep Trueta, 08195 Sant Cugat del Vallès, Barcelona. E-mail: [email protected] ADICCIONES, 2021 · VOL. xx NO. x · PAGES xx-xx Economic evaluations of interventions aimed at the prevention, treatment and/or rehabilitation of alcohol-related disorders: a systematic review lcohol consumption ranks as a leading risk fac- Donaldson, Mugford & Vale (2002) argued for the value tor for mortality and disability around the world, of systematic reviews of economic evaluations as a tool to representing 5.3% of all deaths and 5.1% of all promote evidence-informed health care. They suggest that disability-adjusted life years (DALY) worldwide the value of systematic review of economic evaluation evi- (WorldA Health Organization, 2018). Smyth et al. (2015) dence is not to generate a single authoritative result or rec- confirmed that alcohol misuse was associated with increased ommendation about relative cost effectiveness but, rather, risk of mortality, cancer and injury and an insignificantly re- to help decision makers understand the structure of the duced risk of myocardial infarction. The amount and pat- resource allocation problem and potential impacts. tern of alcohol consumption can have different associations Some systematic reviews have been published, evaluat- with health outcomes and costs. Three decades ago, Burke ing different types of programs, strategies or interventions (1988) already estimated the economic impact of alcohol such as psychological therapies (Meads, Ting, Dretzke & use disorder (AUD) and alcoholism quantifying losses of bil- Bayliss, 2007) and pharmacological treatments (Ndegwa & lions of dollars per year because of lost productivity and em- Cunningham, 2009) from an efficiency point of view, try- ployment. Rehm et al. (2009) stated that the costs associated ing to identify which service provision the National Health with alcohol amount to more than 1% of the gross national Service (NHS) should be promoting to reduce alcohol product in high-income and middle-income countries, with consumption. In addition, other systematic reviews of ef- the costs of social harm constituting a major proportion in fectiveness, such as on mass media campaigns to reduce addition to health costs, and actions to reduce burden and alcohol-impaired driving and alcohol-related crashes (Ya- costs associated with alcohol should be urgently increased. dav & Kobayashi, 2015), community pharmacy interven- Economic Evaluation (EE) is the most relevant tool to tions or alcohol management interventions (Brown et al., health care decision-makers (Goeree & Diaby, 2013) to 2016) have been published, highlighting the most effective compare alternative courses of action both in terms of their in terms of health outcomes. In addition, Barbosa, Godfrey costs and health outcomes. There are four different types & Parrott (2010) carried out a review of the methodology of EEs with the main difference being the way outcomes that was adopted in previous economic evaluations of al- are measured, valued and included in the analysis (Drum- cohol treatment, and they offered research recommenda- mond, Sculpher, Claxton, Stoddard & Torrance, 2015). With tions with a view to enhancing the consistency and harmo- Cost-Effectiveness Analysis (CEA) alternatives are compared nization of economic evaluation in the alcohol usage field. in terms of costs and outcomes, and outcomes are measured The added value of this new review on alcohol-related and valued in natural units collected in clinical trials or ob- economic evaluations is the inclusion of programs distin- servational studies. In a Cost-Utility Analysis (CUA), expect- guishing between treatments for people with alcohol use ed costs and outcomes for each