Patient & Societal Utilities for Alcohol Problems

描述（由申请人提供）：成本效用分析（CUA）是一种以质量调整生命年（QALYs）为度量标准来衡量健康效果的经济评估方法，是评估医疗保健计划相对效率的重要工具。然而，由于缺乏计算QALYs所需的基于社会和患者偏好的酒精相关健康状态和后果的效用权重，CUA在酒精预防和治疗方案中的应用受到限制。本提案的主要目标是严格调查酒精问题效用的定量措施。我们将实现以下具体目标：1)定义和发展与酒精有关的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在接受治疗的酒精问题受试者、他们的重要他人（配偶或同居伴侣）和一般人群中的效用评级；3)比较视觉模拟量表（VAS）、时间权衡量表（TTO）和标准赌博量表（SG）测量酒精相关健康效用的信度和效度；4)前瞻性地测量和比较酒精治疗对象及其重要他人的个人健康状况随时间的效用评级变化。我们将利用利益相关者焦点小组和专家小组制定与酒精有关的健康状况说明。在150名接受酒精治疗的受试者，50名他们的重要他人，以及200名来自一般人群的样本中，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，在效用测量方法上有所不同，在三个研究人群中差异显著，受试者酒精问题严重程度的变化将与他们和他们重要的另一半的个人健康效用评级的变化相关。拟议工作的结果将提供适用于计算质量aly和用于酒精预防和治疗方案的CUA的效用估计。此外，制定与酒精有关的健康状态描述的焦点小组和小组过程将对利益相关者群体之间偏好/价值观的差异产生重要见解，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.