Using patient-level decision modeling to improve use of treatments for alcohol use disorder

项目摘要 酒精使用障碍（AUD），以前是酒精滥用和依赖，是一个重要的公共卫生问题。 在美国，过量饮酒导致93，000人死亡，270万年的潜在寿命损失， 每年花费2500亿美元。2012-13年，美国成年人中AUD的12个月和终生患病率为 分别为14%和29%，较十年前增长超过40%。自2019冠状病毒病以来 大流行，酒精消费量增加更多。过量饮酒会影响各种 身体器官，导致许多健康后果。幸运的是，AUD比普通的AUD更容易治疗。 相信。认知行为疗法、简短干预和动机增强疗法是最常见的 广泛研究的行为干预，并同样有效，而匿名酗酒者（AA）是 大多数人寻求互助小组。药物治疗可以与行为干预相结合， 增加成功。然而，AUD的治疗未得到充分利用。患者的误解， 医生认为，治疗无效是使用的一个重要障碍。另一个是普遍的观点， 成功的治疗需要完全的禁欲。事实上，从澳元中恢复过来可能包括一些酗酒， AUD治疗是有效的。将治疗效果转化为长期健康益处， 有助于说服医生提供治疗并鼓励患者使用它。然而， 单靠随机对照试验（RCT）不能提供这些信息，因为它们不能测量长期的健康结果， 他们也没有对所有治疗方法进行直接比较，因此很难在其中做出选择。仿真 建模提供了一种比较治疗的综合方法，但现有的AUD模型都没有 旨在评估所有治疗。我们设计了一个描述治疗方案的决策辅助（DA），但它确实 由于在编制时缺乏长期惠益的估计数，因此尚未列入这类数据。项目 目的：开发、验证和应用计算机模拟模型，以告知政策制定者、医生 以及AUD治疗的终身受益患者。目标1：开发和验证微观模拟模型 酒精相关并发症的自然史解释了饮酒行为的变化， AUD状态随时间变化。目的2：评估AUD治疗的相对有效性。目标3：纳入 患者和提供者的反馈，以评估增加现有DA的清晰度、内容和可接受性 比较有效性数据。影响：我们的模型将更好地了解预期的 这是一个关于AUD治疗益处的研究，并为决策建模和治疗选择提供了创新方法。 通过将长期有效性数据纳入现有DA，我们的研究将为医生和 患者提供有价值的证据和支持选择最佳治疗的工具，从而帮助关闭 待遇差距。最终，我们的项目将解决NIAAA的研究任务，同时提高质量 数千万美国成年人患有AUD。

Project Summary Alcohol use disorder (AUD), previously alcohol abuse and dependence, is a significant public health problem. In the US, excessive alcohol use is responsible for 93,000 deaths and 2.7 million years of potential life lost, at a cost of $250 billion annually. In 2012-13, the 12-month and life-time prevalence of AUD in US adults was 14% and 29%, respectively, increasing by more than 40% from a decade earlier. Since the Covid-19 pandemic, alcohol consumption has increased even more. Excessive alcohol consumption affects various bodily organs, leading to many health consequences. Fortunately, AUD is more treatable than commonly believed. Cognitive behavioral therapy, brief interventions, and motivational enhancement therapy are the most widely studied behavioral interventions and are similarly efficacious, while Alcoholics Anonymous (AA) is the most sought out mutual support group. Pharmacotherapy can be combined with behavioral interventions to increase success. However, treatments for AUD are underutilized. The misconception among patients and physicians that treatment is ineffective is an important obstacle to use. Another is the common view that treatment success requires total abstinence. In reality, recovery from AUD can include some heavy drinking, and AUD treatment can be effective. Expressing treatment effectiveness into long-term health benefits could help convince physicians to offer treatment and encourage patients to use it. However, randomized controlled trials (RCTs) alone cannot provide this information because they do not measure long-term health outcomes, nor do they compare all treatments head-to-head, making it difficult to choose among them. Simulation modeling offers a comprehensive approach to comparing treatments, but none of existing AUD models were designed to assess all treatments. We designed a decision aid (DA) describing treatment options, but it does not yet include estimates of long-term benefits due to lack of such data at the time of development. Project objective: To develop, validate, and apply a computer simulation model to inform policy makers, physicians, and patients of the lifetime benefit of treatments for AUD. Aim 1: Develop and validate a microsimulation model of the natural history of alcohol-associated complications accounting for the change in drinking behaviors and AUD status over time. Aim 2: Assess the comparative effectiveness of AUD treatments. Aim 3: Incorporate patient and provider feedback to assess the clarity, content, and acceptability of augmenting an existing DA with comparative effectiveness data. Impact: Our model will offer a better understanding of the expected benefit of AUD treatments and provide an innovative approach to decision modeling and treatment selection. By incorporating long-term effectiveness data into an existing DA, our study will provide physicians and patients with valuable evidence and a tool to support selection of optimal treatments, thereby helping to close the treatment gap. Ultimately, our project will address NIAAA’s research missions while improving the quality of life for tens of millions of US adults suffering from AUD.