Alcohol consumption and related comorbid conditions: health state utilities for economic evaluation

项目总结 在美国有效预防和治疗酒精使用障碍(AUD)可以节省8万多人 每年都活着。尽管禁欲传统上是澳大利亚糖尿病干预的目标，但减少 研究表明，饮酒水平可以降低澳元的危害，为健康提供了额外的“目标岗位” 预防和治疗。与此同时，以患者为中心的护理和患者报告的结果正在产生 对医疗保健决策的影响比以往任何时候都要大。因此，迫切需要严格的 酒精健康服务研究，为实践和政策提供信息。此外，至关重要的是，这项研究必须与 以医学为重点的卫生服务研究，以巩固比较评估中的“公平竞争环境” 资源分配决策。 这些资源分配决策越来越多地由成本效益分析提供信息，这些分析使用 作为一种结果的健康效用。健康效用捕获个人在给定健康状态下的生活偏好，并 是质量调整寿命年(QALY)的基础，是衡量成本效益的首选结果指标 分析。然而，酒精健康服务研究人员很少使用健康公用事业和QALY。匮乏 酒精健康州的健康公用事业是酒精健康服务研究的一个严重缺陷， 酒精服务在资源分配决策中处于不利地位。 为了促进在酒精健康服务研究中使用卫生公用事业，我们将进行辅助数据 全国酒精及相关疾病流行病学调查III(NESARC-III)应解决的问题分析 以下是具体目标： 目标1：评估按酒精消费水平分层的澳大利亚健康状态的健康状态效用。 1.1根据DSM-5严重程度和世卫组织风险水平估计AUD健康状态的平均效用和方差。 1.2相邻健康状态之间的测试效用差异，以告知AUD严重性降低的影响 和/或消费水平。 目的2：经验性和预测性地得出AUD并发疾病的联合健康状况效用。 2.1估计过去一年的平均效用和方差，以及选定的共生条件。 2.2测试用于估计澳大利亚联合健康状态效用的预测算法的性能。 作为一个区域项目，我们将让研究生和本科生参与到研究的各个方面，如 研究团队中不可或缺的成员，提供深入的研究接触和培训。我们会 将我们的成果传播给临床、实践、政策和研究团体，以促进卫生保健的使用 在酒精健康服务研究中的效用。我们的发现将导致卫生公用事业和QALY的更广泛使用 用于酒精健康服务的政策和临床决策，从而改善患者和 人口健康。 1

PROJECT SUMMARY Effective prevention and treatment of alcohol use disorder (AUD) in the US could save more than 80,000 lives each year. Although abstinence has traditionally been the goal of AUD interventions, reductions in drinking levels have been shown to decrease the harms of AUD, providing an additional “goal post” for prevention and treatment. At the same time, patient-centered care and patient-reported outcomes are having a greater impact on health care decision-making than ever before. Thus, there is an urgent need for rigorous alcohol health services research to inform practice and policy. Moreover, it is critical that this research parallel medically-focused health services research to solidify a “level playing field” in comparative assessments for resource allocation decisions. Increasingly these resource allocation decisions are informed by cost-effectiveness analyses that use health utility as an outcome. Health utility captures individuals’ preferences for living in a given health state and is the foundation of quality adjusted life years (QALYs), the preferred outcome measure for cost-effectiveness analysis. Health utilities and QALYs are rarely used by alcohol health services researchers, however. The lack of health utilities for alcohol health states is a critical shortcoming in alcohol health services research that disadvantages alcohol services in resource allocation decisions. To promote the use of health utilities in alcohol health services research, we will conduct secondary data analyses of the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) to address the following specific aims: Aim 1: Estimate health state utilities for AUD health states stratified by alcohol consumption levels. 1.1 Estimate mean utility and variance for AUD health states based on DSM-5 severity and WHO risk levels. 1.2 Test utility differences between adjacent health states to inform the impact of reductions in AUD severity and/or consumption levels. Aim 2: Empirically and predictively derive joint health state utilities for AUD with comorbid conditions. 2.1 Estimate mean utility and variance for past year AUD with select comorbid conditions. 2.2 Test the performance of predictive algorithms for estimating joint health state utilities in AUD. As an AREA project, we will involve graduate and undergraduate students in all aspects of the study as integral members of the research team, providing intensive exposure to and training in research. We will disseminate our results to the clinical, practice, policy, and research communities to advance the use of health utility in alcohol health services research. Our findings will result in broader use of health utilities and QALYs for policy and clinical decision making in alcohol health services, and thereby lead to improved patient and population health. 1