Patient & Societal Utilities for Alcohol Problems

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DESCRIPTION (provided by applicant): Cost-utility analysis (CUA), a type of economic evaluation in which health effects are measured in the metric of Quality-Adjusted Life-Years (QALYs), is a valuable tool for assessing the relative efficiency of health care programs. However, the application of CUA to alcohol prevention and treatment programs is limited by the absence of the societal and patient preference-based utility weights for alcohol-related health states and consequences needed to calculate QALYs. The main goal of this proposal is to rigorously investigate quantitative measures of utility for alcohol problems. We will achieve the following specific aims: 1) define and develop health state descriptions for a spectrum of alcohol-related health states; 2) measure and compare utility ratings for the spectrum of alcohol-related health states defined in Aim #1 in subjects with alcohol problems in treatment, their significant others (spouse or live-in partner), and in the general population; 3) compare the reliability and validity of the visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG) methods for measuring alcohol-related health utilities; and 4) prospectively measure and compare changes in utility ratings over time for the personal health status of alcohol treatment subjects and their significant others. We will use focus groups of stakeholders and an expert panel to develop the alcoholrelated health state descriptions. In a sample of 150 subjects entering alcohol treatment, 50 of their significant others, and 200 subjects from the general population, we will test the hypotheses that utility ratings for alcohol-related health states decrease as the severity of the health state increases, differ by utility measurement method, differ significantly among the three study populations, and that changes in the severity of a subject's alcohol problem will correlate with changes in their and in their significant other's personal health utility rating. Results of the proposed work will provide utility estimates suitable for calculating QALYs and using in CUA of alcohol prevention and treatment programs. In addition, the focus group andpanel process for developing the alcohol-related health state descriptions will yield important insights into differences in preferences/values among the stakeholder groups and will guide future research.