THE COST-EFFECTIVENESS OF TREATMENT FOR ALCOHOLISM - A 2ND APPROXIMATION

Objective: This review builds on the innovative research synthesis of Holder and his colleagues, addresses some of the limitations of the bo x-score approach to assessing treatment effectiveness that they used a nd provides a second approximation of the cost-effectiveness of treatm ent for alcoholism. Method: For each of 141 comparative treatment stud ies, we determined whether or not it found at least one statistically significant positive effect on a drinking-related outcome variable for each of the modalities examined in a paired contrast with one other c ondition. We next calculated the predicted probability of each study y ielding at least one statistically significant treatment effect, based on the number of tests for treatment effects conducted. Following tha t, for each study of a particular treatment modality, the strength of the ''weakest competitor'' against which the modality had been compare d was determined. For each modality, we used the average predicted pro bability of the relevant studies finding a significant effect and the average effectiveness of the weakest competitor to predict the modalit y's effectiveness. Results: We calculated an Adjusted Effectiveness In dex (AEIn) for each modality, which was the difference between its pre dicted and actual effectiveness score. Our AEIn results were consisten t with those of Holder et al. in suggesting that some of the same moda lities appear to be effective or ineffective. Our results differed fro m their findings with respect to other modalities, however. Using data presented by Holder and his colleagues on the minimum estimated cost of providing different modalities, we offer a second approximation of the modalities' cost-effectiveness. Conclusions: Overall, we found a s maller range of effectiveness across modalities than did Holder and hi s colleagues and a non-significant relationship between cost and effec tiveness. Like Holder et al., we do not believe major treatment provis ion or funding decisions should be based solely on this type of review .