Economic aspects of clinically effective and efficient models of health services in alcohol addiction treatment - Part I + II

Research areas: Psychological & psychiatric interventions, Health economics

Philipp Radlberger
Duration: October 2007 - Mai 2009

Period (Part 1): October 2007 - August 2008
Period (Part 2): September 2008 - Mai 2009
Period (Part 3): September 2009 - April 2010
Proposed by: SALK; academic dissertation
Publication Part 1+2: HTA Project Report 10 - https://eprints.aihta.at/823/

Completed:
Part 1: International models and approaches of outcome measurement
Part 2: Selected models of integrated care and their evaluation

Ongoing:
Part 3: Comparison of services and costs in practical context: economic analysis of therapeutic institutions in Traun and Kalksburg

Background:
Increasingly, psychiatric and socio-medical therapeutic institutions have to deal with the discussion and measurement of their outcomes. Given this fact, the project, which is structured in three parts, aims to produce a synthesis of published knowledge and its analysis in order to gain new knowledge for concrete evaluations of therapeutic institutions. Several highly heterogeneous approaches exist in the organisation of the services: easily accessible out-patient therapies, day-care, as well as in-patient services. There is relatively little comparative evidence of clinical effectiveness of the different approaches, treatment results and costs.

Aims and research objectives:
To give an overview of the different treatment models, to analyse some models of integrated care, to reach conclusions about the evaluation of cost-effectiveness analysis of in- and out-patient therapies for people suffering from alcohol addiction, to transfer the main features of a model of integrated care services to the region of Salzburg and to carry out an economic evaluation of the existing and a potential integrated care model.

Method:
Part 1: Systematic review, literature- and data analysis;

Part 2: Additional search of published and grey literature; hand search and internet research for chosen models of good practice; direct contact and expert interviews; systematic organisation analysis of the three examples of integrated care according to their procedural design, gateway communication structures; analysis of grey literature and cost data available; formulation of quality indicators which could be benchmarks for other models of service of integrated care in alcohol addiction treatment;

Part 3: Expert (group-)interviews, clinical and cost data description, cost-consequence analysis:
• description of actual structure of financing
• definition of outcome parameters in clinical records
• description of cost data
• identification of successful treatment in clinical records
• cost-consequence analysis

Results:
Part 1: Typologies of diagnosis and treatment planning are internationally incoherent. Some systematisations of health services are more advanced than others. There is a wide spectrum of alternative treatments including medical interventions in short intervention withdrawal, psychotherapies, group-, family- and behavioural therapies as well as relapse prevention measures and labour market reintegration facilities. According to the model of service supply, in-patient, out-patient or day care settings are chosen. Case management approaches implying individual carers helping with organising and coordinating flexible treatment structures stand in opposition to treatment strategies where therapy plans are strictly fixed and scheduled immediately after diagnosis. Apart from evidence on clinical effectiveness, economic arguments can also influence the structures of health service supply. The fact that most countries are initiating screening programs is indicating that the economic importance of prevention is more and more recognised. General practitioners as gatekeepers can be considered key actors from an organisational point of view.

Part 2: The comparison of three projects of integrated care in terms of combination of in- and out-patient treatments was done on the three levels of structure, processes and results. The “addiction therapy in a linked system/EVS” centres the gateway management of institutional elements as a key quality indicator for the system by introducing a communication matrix. The evaluation of the Jellinek-model uses an adapted quality management tool for enterprises. Even though the UKATT as a big RCT with an economic piggyback-design put the focus on clinical outcome parameters, authors agree with the two other evaluations in considering the retention rate as highly relevant.

Discussion:
Overall there are many well evaluated single interventions, but only very few coordinated models of integrated alcohol therapy. Those who exist are mostly young, which explains a lack of evidence in the field of quality measurement. The analysis of a few regional pilot projects shows the high explanatory relevance of gateway management and retention rate for the overall quality of a treatment system in alcohol addiction.

Publication (Part 1 & 2):
HTA Project report 10 - https://eprints.aihta.at/823/