Modeling the Impact of a long-term horizon and multiple treatment episodes on the effectiveness and cost-effectiveness of alcohol treatment in the United States

Background: Low alcohol use disorders (AUD) treatment uptake might be due to the perception that treatment is not effective. Most alcohol clinical studies have short follow-up periods, underestimating the full benefits of alcohol treatment. In addition, clinical studies only consider one treatment cycle, and do not account for the need of multiple treatment episodes for a chronic recurrent condition.

Methods: A validated microsimulation model of the long-term drinking patterns for people with AUD was used to simulate 10,000 individuals resembling those of the COMBINE trial in the United States. The model was used to (1) assess the impact of a long-term horizon on the cost-effectiveness of alcohol treatment and (2) assess the impact of multiple treatment episodes on the cost-effectiveness of alcohol treatment. Alcohol treatment arms from the trial were combined. Main outcomes included health care costs, crime costs, labor market productivity, life expectancy, quality-adjusted life years (QALYs), and number of alcohol-related hospitalizations and deaths.

Results: The cost per QALY of alcohol treatment decreased from $55,590 after one year to $78 when healthcare costs and QALYs were tracked for lifetime. When a societal perspective that also accounts for crime and labor productivity is adopted, treatment is cost-saving over all time frames. Under both perspectives, access to multiple treatment episodes dominates no-treatment and one-episode scenarios. From a healthcare perspective, the incremental cost per QALY for increasing from a maximum of two to four treatment episodes is $499, and from four to unlimited episodes is $5,049. The unlimited treatment scenario dominates all other scenarios from a societal perspective. Results were robust to sensitivity analyses.

Conclusions: A long-term perspective and multiple episodes of alcohol treatment improve the cost-effectiveness of AUD treatment, and when the societal impacts of AUD are included, treatment is cost-saving. Our results further support the value of alcohol treatment.