Patient & Societal Utilities for Alcohol Problems

描述（由申请人提供）：成本效用分析（CUA）是一种经济评估，其中健康影响以质量调整生命年（QHLS）为度量标准，是评估医疗保健计划相对效率的有价值工具。然而，CUA的酒精预防和治疗计划的应用是有限的，缺乏社会和患者偏好为基础的效用权重酒精相关的健康状况和后果需要计算QOLS。该提案的主要目标是严格调查酒精问题的实用性的定量措施。我们将实现以下具体目标：1）定义和开发酒精相关健康状态谱的健康状态描述; 2）测量和比较目标1中定义的酒精相关健康状态谱的效用评级，治疗中有酒精问题的受试者，他们的重要他人（配偶或同居伴侣）和一般人群; 3）比较视觉模拟评分法（VAS）、时间权衡法（TTO）、和测量酒精相关健康效用的标准赌博（SG）方法;以及4）前瞻性地测量和比较酒精治疗受试者及其重要他人的个人健康状况的效用评级随时间的变化。我们将利用利益相关者的焦点小组和专家小组来制定与酒精相关的健康状况描述。在150名接受酒精治疗的受试者、50名他们的重要他人和200名来自普通人群的受试者的样本中，我们将检验以下假设：酒精相关健康状态的效用评级随着健康状态严重程度的增加而降低，效用测量方法不同，三个研究人群之间存在显著差异，并且受试者酒精问题严重性的变化将与他们和他们的重要他人的个人健康效用等级的变化相关。建议的工作结果将提供实用的估计，适用于计算的QELS和使用在CUA的酒精预防和治疗计划。此外，焦点小组和小组的过程中，制定酒精相关的健康状况的描述将产生重要的见解的利益相关者群体之间的偏好/价值观的差异，并将指导未来的研究。

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.