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EFFECTIVE AND COST-EFFECTIVE MEASURES TO REDUCE ALCOHOL MISUSE IN SCOTLAND: AN UPDATE TO THE LITERATURE REVIEW
SECTION EIGHT: DETOXIFICATION
SUMMARY
This section reviews the effectiveness and cost-effectiveness evidence relating to detoxification treatments. The main findings of the previous review were;
benzodiazepines are the first choice therapy on the basis of safety and effectiveness;
outpatient treatment is safe and effective for mild to moderate symptoms;
a small study of home detoxification in Australia found better outcomes at lower cost when compared with matched inpatient treatment; and
a US study found that outpatient treatment was significantly cheaper per successful detoxification.
No additional effectiveness reviews were identified in the update. One study of costs and outcomes in France was identified but the results need to be interpreted with care.
More information is needed about treatment settings, providers and intensity of treatment in a UK context.
INTRODUCTION
8.1 Detoxification refers to the period during which patients become alcohol free. The effectiveness of interventions for managing alcohol withdrawal syndrome was reviewed in the previous report (Ludbrook et al 2002). No new reviews of effectiveness were identified for this update. One economic study is described below.
COST-EFFECTIVENESS
Costs and outcomes
8.2 Nalpas et al (2003) report on the costs and outcomes of detoxification and one year follow up for 4 centres in France. This was an open, non-randomised study. Costs were based on official reimbursement rates.
8.3 The main factor in the difference in follow up cost for centre 1 was due to inpatient stays in the post withdrawal unit.
8.4 The authors calculate an index of efficiency, which they define as the cost of preventing the relapse of one patient for one month and this is similar for all centres. Centre 1 is regarded as more effective because of the longer mean time without relapse. However, this comparison must be biased to some extent by the longer or more frequent stays in the post withdrawal unit at this centre, as the opportunity to relapse is restricted.
Table 8.1 Costs and outcomes by centre
Center | Patient | Mean | Inpatient | Follow up | Mean time without |
| numbers | stay (days) | mean cost | mean cost | relapse (months) |
1 | 94 | 11 | €1327 | €1704 | 5.89 |
2 | 50 | 28 | €1765 | €690 | 3.73 |
3 | 48 | 19 | €1917 | €419 | 4.94 |
4 | 75 | 19 | €1398 | €435 | 3.77 |
Source: Nalpas et al (2003)
FURTHER RESEARCH
8.5 Studies that provide direct comparisons of different drug interventions are still required. There are no studies of the added value for drugs that are seen as an adjunct to the main therapy. More information is required about treatment settings, providers and intensity of treatment in a UK context.
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