The cost-effectiveness of treatment for alcoholism: A second approximation
The cost-effectiveness of treatment for alcoholism: A second approximation
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DOI：
10.15288/jsa.1996.57.229
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发表时间：
1996-05-01
期刊：
影响因子：
--
通讯作者：
Monahan, SC
中科院分区：
文献类型：
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作者：
Finney, JW;Monahan, SC
目的：这篇综述建立在保持器和他的同事们的创新研究综合的基础上，解决了他们使用的盒子评分方法评估治疗效果的一些局限性，并提供了第二个近似的酗酒治疗的成本效益。方法：对于141项比较治疗研究中的每一项，我们确定是否发现与其他条件配对对比的每种方式对饮酒相关结局变量至少有一个统计学显著的积极影响。接下来，我们根据进行的治疗效应检验次数，计算了每项研究产生至少一种统计学显著性治疗效应的预测概率。之后，对于每一项特定治疗方式的研究，确定与该方式进行比较的“最弱竞争者”的实力。对于每种形式，我们使用相关研究的平均预测概率发现一个显着的效果和最弱的竞争对手的平均有效性来预测该形式的有效性。结果如下：我们计算了每种方式的调整后有效性指数（AEIn），即其预测和实际有效性评分之间的差异。我们的AEIn结果与保持器等人的结果一致，表明一些相同的方式似乎是有效或无效的。然而，我们的结果与其他模式的结果不同。利用保持器和他的同事提供的关于提供不同模式的最低估计成本的数据，我们提供了模式的成本效益的第二个近似值。结论：总的来说，我们发现，与保持器和他的同事相比，不同模式的有效性范围较小，成本和有效性之间的关系不显著。像保持器等人一样，我们认为，提供重大治疗或作出拨款决定，不应只以这类检讨为依据。
Objective: This review builds on the innovative research synthesis of Holder and his colleagues, addresses some of the limitations of the box-score approach to assessing treatment effectiveness that they used and provides a second approximation of the cost-effectiveness of treatment for alcoholism. Method: For each of 141 comparative treatment studies, we determined whether or not it found at least one statistically significant positive effect on a drinking-related outcome variable for each of the modalities examined in a paired contrast with one other condition. We next calculated the predicted probability of each study yielding at least one statistically significant treatment effect, based on the number of tests for treatment effects conducted. Following that, for each study of a particular treatment modality, the strength of the ''weakest competitor'' against which the modality had been compared was determined. For each modality, we used the average predicted probability of the relevant studies finding a significant effect and the average effectiveness of the weakest competitor to predict the modality's effectiveness. Results: We calculated an Adjusted Effectiveness Index (AEIn) for each modality, which was the difference between its predicted and actual effectiveness score. Our AEIn results were consistent with those of Holder et al. in suggesting that some of the same modalities appear to be effective or ineffective. Our results differed from their findings with respect to other modalities, however. Using data presented by Holder and his colleagues on the minimum estimated cost of providing different modalities, we offer a second approximation of the modalities' cost-effectiveness. Conclusions: Overall, we found a smaller range of effectiveness across modalities than did Holder and his colleagues and a non-significant relationship between cost and effectiveness. Like Holder et al., we do not believe major treatment provision or funding decisions should be based solely on this type of review.