A cost-effectiveness analysis of two psychological treatments for controlled drinking in individuals alcohol use disorder

Abstract

Background and aims: In Sweden, up to 7% of people exhibit harmful alcohol use or dependency, but only a small fraction (10–20%) pursue treatment. While Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) are effective for alcohol use disorders (AUD), their cost-effectiveness has not been studied. This research evaluates the cost-effectiveness of BSCT and MET in treating AUD, focusing on achieving controlled drinking from both a healthcare and limited societal perspective. Design, setting, and participants: A Markov model was created to compare the cost-effectiveness of BSCT and MET for treatment-seeking individuals with AUD. This model simulated a sample of patients with AUD over five years, calculating the costs and outcomes for both treatments. It used a cost-utility analysis to determine the cost per quality-adjusted life year (QALY). The model accounted for varying levels of alcohol intake and related health complications. Efficacy data came from a randomized trial, with complication risks, costs, utilities, and mortality rates drawn from existing literature. Intervention and comparator: BSCT, consisting of five sessions, was compared to MET, constituted by four sessions. Measurements: The primary outcome was cost per QALY. Probabilistic and univariate sensitivity analyses were performed to estimate how parameter uncertainty affected model outputs. Findings: BSCT proved less costly than MET, yielding savings in healthcare costs by $50.52 and societal costs by $118.12 on average per person. Additionally, BSCT demonstrated an advantage in QALYs, with a gain of 0.060 QALYs per patient over MET. Sensitivity analyses confirmed the robustness of these results, indicating that BSCT is the cost-effective treatment option. Conclusions: In comparison to MET, BSCT is less costly and more beneficial for health, indicating its potential as a valuable treatment option for individuals with AUD targeting controlled drinking. The model can be applied to assess the cost-effectiveness of various other AUD treatment interventions.