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

项目摘要 在美国，有效预防和治疗酒精使用障碍（AUD）可以节省8万多美元 生活每年。虽然禁欲传统上是AUD干预的目标，但 饮酒水平已被证明可以降低AUD的危害，为 预防和治疗。与此同时，以病人为中心的护理和病人报告的结果正在成为一个新的趋势。 对医疗保健决策的影响比以往任何时候都大。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，这项研究平行 以医学为重点的卫生服务研究，以巩固比较评估的“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通过成本效益分析来了解， 健康作为一种结果。健康效用捕捉个人在给定健康状态下生活的偏好， 是质量调整生命年（QELS）的基础，QELS是成本效益的首选结果测量 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QALOS。缺乏 酒精健康状况的健康效用是酒精健康服务研究中的一个关键缺陷， 在资源分配决策中处于不利地位的酒精服务。 为了促进在酒精健康服务研究中使用健康公用事业，我们将进行二级数据 分析全国酒精和相关疾病流行病学调查-III（NESARC-III），以解决 具体目标如下： 目的1：估计健康状态效用为AUD健康状态分层的酒精消费水平。 1.1根据DSM-5严重程度和WHO风险水平估计AUD健康状态的平均效用和方差。 1.2测试相邻健康状态之间的效用差异，以告知AUD严重程度降低的影响 和/或消费水平。 目的2：经验性和预测性地推导出合并有合并症的AUD的联合健康状态效用。 2.1估计过去一年AUD的平均效用和方差，并选择合并症。 2.2测试用于估计关节健康状态效用的预测算法的性能（AUD）。 作为一个区域项目，我们将涉及研究生和本科生在研究的各个方面， 研究团队的组成成员，提供密集的接触和研究培训。我们将 将我们的研究结果传播给临床、实践、政策和研究界，以促进健康 酒精健康服务研究中的效用。我们的研究结果将导致更广泛地使用卫生公用事业和质量保证体系 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