Willingness to pay vs lottery equivalent to value the impact of alcohol misuse on quality of life.

OBJECTIVES: To estimate the impact of alcohol disorders using lottery equivalent (LE) and willingness to pay (WTP) methods and compute the WTP for a QALY (WTP-Q) derived from these values. METHODS: Two samples of 300 people valued nine states of alcohol misuse. LE and WTP were used in sample 1 and 2, respectively. The ability to discriminate between methods was tested. Regression models were performed to estimate the preference weights of dimensions. Several values of WTP-Q were obtained by combining the estimated values from both samples. RESULTS: LE and WTP produce the same ranking of states but LE is more sensitive. The estimated impact of the nine states ranges between 0.91 and 0.22 QALYs, and the WTP for avoiding them ranges between €10,444 and €4132. WTP-Q varies between €11,473 and €19,092 when the mean values of the states are used. The WTP-Q tends to decrease with the severity. CONCLUSIONS: Although LE and WTP provide values for cost-utility and cost-benefit analyses, respectively, LE seems to be preferable for measuring the impact of alcohol disorders. As the lower sensitivity of WTP seems to explain a WTP-Q decrease with severity, more research is needed before recommending the use of different WTP-Q values.

Eliciting Health State Utilities Using Paired-Gamble Methods: The Role of the Starting Point.

BACKGROUND: Paired-gamble methods have been proposed to avoid the "certainty effect" associated with standard gamble methods. OBJECTIVE: This study examines the role of starting-point effects in paired-gamble methods. In particular, it examines how the utilities so derived vary as a function of the probabilities of the stimulus lottery. METHODS: A sample of 455 members of the Spanish general population valued 9 health states via face-to-face interviews. Subjects were randomly placed into 3 subgroups, which differed in terms of the stimulus gamble's probability. Nonparametric tests and an interval regression model were used to test if utilities change when the probability distribution is modified. RESULTS: Nonparametric tests showed that the probability of a health state being considered worse than death did not differ among subgroups. Nevertheless, changes in the stimulus gamble did produce significant differences in the distribution of utilities: the higher the probability of full health in the stimulus, the higher the utility elicited. Regression estimates support the existence of starting-point effects when the utilities are obtained under expected utility. According to the prospect theory, the conclusions depend on the reference point considered. When the reference points used are death or the health state evaluated, we observe differences among these groups. Nevertheless, when full health is used, these differences disappear. CONCLUSION: This research suggests that paired-gamble methods may also be susceptible to starting-point effects. Yet the differences are small, and they disappear when the data are analyzed using prospect theory with full health as the reference point.

Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study. / Costes intangibles de la dependencia alcohólica desde la perspectiva de los pacientes y sus familiares: un estudio de valoración contingente.

Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (100% and 50%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 100% and 50% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used.

La dependencia alcohólica produce múltiples problemas no sólo a la persona que la padece sino también a su entorno. En este estudio se utiliza la valoración contingente para valorar los efectos intangibles de la dependencia alcohólica, desde la perspectiva de las personas directamente implicadas: pacientes y familiares. Se ha entrevistado a 145 pacientes y 61 familiares. Los efectos intangibles de la dependencia alcohólica se obtienen a partir de la disponibilidad a pagar por un hipotético tratamiento para la dependencia, ante dos escenarios de éxito (50% y 100%). La disponibilidad a pagar media mensual de la población alcohólica es de 129€ y 168€, respectivamente, por los tratamientos con un 50% y un 100% de éxito. La disponibilidad de los familiares es mayor en ambos escenarios (307€ y 420€, respectivamente), lo cual podría ser explicado por su mayor percepción de los problemas familiares, laborales y de salud generados por la dependencia alcohólica. El análisis de regresión realizado muestra que la eficacia del tratamiento, la renta personal y tener un deterioro moderado de la salud influyen positivamente en la disponibilidad a pagar de los pacientes, e influye negativamente estar desanimado y deprimido. Los resultados de este estudio pueden ser aplicados a estudios de evaluación económica cuyo objetivo es medir los beneficios de programas destinados a reducir la prevalencia de la dependencia alcohólica. Los costes intangibles estimados pueden ser añadidos a los costes directos e indirectos habitualmente utilizados.

Costes intangibles de la dependencia alcohólica desde la perspectiva de los pacientes y sus familiares: un estudio de valoración contingente / Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study

La dependencia alcohólica produce múltiples problemas no sólo a la persona que la padece sino también a su entorno. En este estudio se utiliza la valoración contingente para valorar los efectos intangibles de la dependencia alcohólica, desde la perspectiva de las personas directamente implicadas: pacientes y familiares. Se ha entrevistado a 145 pacientes y 61 familiares. Los efectos intangibles de la dependencia alcohólica se obtienen a partir de la disponibilidad a pagar por un hipotético tratamiento para la dependencia, ante dos escenarios de éxito (50% y 100%). La disponibilidad a pagar media mensual de la población alcohólica es de 129€ y 168€, respectivamente, por los tratamientos con un 50% y un 100% de éxito. La disponibilidad de los familiares es mayor en ambos escenarios (307€ y 420€, respectivamente), lo cual podría ser explicado por su mayor percepción de los problemas familiares, laborales y de salud generados por la dependencia alcohólica. El análisis de regresión realizado muestra que la eficacia del tratamiento, la renta personal y tener un deterioro moderado de la salud influyen positivamente en la disponibilidad a pagar de los pacientes, e influye negativamente estar desanimado y deprimido. Los resultados de este estudio pueden ser aplicados a estudios de evaluación económica cuyo objetivo es medir los beneficios de programas destinados a reducir la prevalencia de la dependencia alcohólica. Los costes intangibles estimados pueden ser añadidos a los costes directos e indirectos habitualmente utilizados

Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (50% and 100%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 50% and 100% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used

Measuring the impact of alcohol-related disorders on quality of life through general population preferences / Medición del impacto de los trastornos relacionados con el alcohol en la calidad de vida a partir de las preferencias sociales

Objective: To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences Methods: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated. Results: Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%). Conclusions: Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications (AU)

Objetivo: Estimar los efectos intangibles del consumo abusivo de alcohol en la calidad de vida del bebedor, según las preferencias sociales. Métodos: Los efectos más relevantes se identificaron mediante dos grupos focales realizados con pacientes y especialistas. Los niveles de estas dimensiones se combinaron para producir diferentes escenarios. Una muestra de 300 personas de la población general española evaluó un subconjunto de estos escenarios, seleccionados mediante un diseño factorial fraccional. Se utilizó el método de lotería equivalente para obtener la utilidad asociada a cada uno de los escenarios evaluados. Para estimar la importancia relativa de cada dimensión y obtener la utilidad para el resto de escenarios no evaluados se estimó una regresión con efectos aleatorios. Resultados: Se identificaron cuatro efectos intangibles relevantes (familia, salud física, salud psicológica y social) con tres niveles de intensidad. Las utilidades asociadas a cada uno de los escenarios evaluados presentan una amplia variación (entre 0,09 y 0,78). La dimensión con mayor importancia relativa son las consecuencias en la salud física (36,4%) y las consecuencias en la familia (31,3%), seguidas de las consecuencias psicológicas (20,5%) y las sociales (11,8%). Conclusiones: Nuestros resultados confirman la conveniencia de adoptar un enfoque heterogéneo para medir los efectos del abuso del alcohol. Las utilidades estimadas podrían tener aplicaciones tanto clínicas como económicas (AU)

Measuring the impact of alcohol-related disorders on quality of life through general population preferences.

OBJECTIVE: To estimate the intangible effects of alcohol misuse on the drinker's quality of life, based on general population preferences METHODS: The most important effects (dimensions) were identified by means of two focus groups conducted with patients and specialists. The levels of these dimensions were combined to yield different scenarios. A sample of 300 people taken from the general Spanish population evaluated a subset of these scenarios, selected by using a fractional factorial design. We used the probability lottery equivalent method to derive the utility score for the evaluated scenarios, and the random-effects regression model to estimate the relative importance of each dimension and to derive the utility score for the rest of scenarios not directly evaluated. RESULTS: Four main dimensions were identified (family, physical health, psychological health and social) and divided into three levels of intensity. We found a wide variation in the utilities associated with the scenarios directly evaluated (ranging from 0.09 to 0.78). The dimensions with the greatest relative importance were physical health (36.4%) and family consequences (31.3%), followed by psychological (20.5%) and social consequences (11.8%). CONCLUSIONS: Our findings confirm the benefits of adopting a heterogeneous approach to measure the effects of alcohol misuse. The estimated utilities could have both clinical and economic applications.

Desintoxicación ambulatoria de alcohol: una opción segura / Out patient alcohol addiction treatment: a safe option

OBJETIVOS: demostrar la seguridad del proceso de desintoxicación ambulatoria de la dependencia alcohólica. METODOLOGÍA: análisis retrospectivo de 100 desintoxicaciones indicadas en la Unidad de Alcoholismo de Vigo, recogiendo las siguientes variables: sexo, edad, ámbito de desintoxicación, fármaco utilizado para la desintoxicación, otros fármacos para deshabituación (aversivos, anti-craving), desintoxicación completada, sintomatología de abstinencia leve, moderada o grave. Se utilizó para la desintoxicación Clometiazol en 66 casos, Tetrabamato en 29 y benzodiacepinas en 3 casos. Se cruzaron las variables estudiadas con la presencia o no de síntomas de abstinencia, utilizando la prueba del chi cuadrado. RESULTADOS: Se completó la desintoxicación ambulatoria en 88 casos sin la aparición de síntomas; aparecieron síntomas leves o moderados en 15 casos y ninguno presentó síntomas graves de abstinencia. Solo 2 casos precisaron ingreso hospitalario. Ninguna variable se correlaciona con la aparición de síntomas de abstinencia. CONCLUSIÓN: La desintoxicación ambulatoria es un proceso seguro, una vez excluida causa de ingreso

GOAL: to show that out-patient detoxification is a safe process to treat alcoholic addiction. METHODS: a retrospective analysis of 100 detoxifications reported in the Alcoholism Unit of Vigo was performed. The following variables were included in the study: gender, age, detoxification environment, main drug used for detoxification, other drugs used for alcoholism treatment (aversive, anticraving), complete detoxification; symptoms of slight, moderate or serious abstinence. The following drugs were used for detoxification: Clometiazol in 66 cases, Tetrabamato in 29 and benzodiazepines in 3. A comparison analysis of these variables was carried out using the chi square test. RESULTS: The out-patient detoxification was successfully completed in 88 cases; slight or moderate symptoms of abstinence showed up in 15 cases, and none of them had serious symptoms of abstinence. Only 2 cases needed to be hospitalized. CONCLUSION: Out-patient detoxification is a safe process, if a reason for hospitalization is excluded