Home Visits: A Cost-effective Option for the Treatment of Alcohol Dependence

Alcohol, Other Drugs, and Health: Current Evidence

Home visits may improve care, quality of life, and treatment adherence in some patients. Researchers from Brazil compared the cost-effectiveness of outpatient treatment (OT) with OT plus home visits (HV) among 120 people with alcohol dependence as part of a randomized controlled trial. Both groups received 20 group motivational interviewing sessions in 3 months. At the beginning of treatment, patients in the intervention group received 4 HV geared toward improving adherence. Patients who dropped out were considered nonabstinent.

• Dropouts were more common in the OT group (38% versus 15%).

• Fifty-eight percent of patients in the HV group were abstinent at 3 months compared with 43% in the OT group (p=0.1).

• Compared with OT, the additional total cost of HV (including medical, productivity, and other costs) to achieve 1 more abstinent patient was US $1,852.

• In sensitivity analyses biased against HV, HV cost $2,334 per 1 more abstinent patient compared with OT.

Comments:

Economic analyses are crucial when resources are scarce. These results indicate that HV may be cost-effective when treating alcohol dependence; however, more efficacy studies are needed before reaching this conclusion. Findings are limited by a high drop-out rate, short follow-up period, small sample size, and absence of a statistically significant difference between groups in the proportion of abstinent patients at the end of treatment. Nevertheless, the findings provide important information regarding the potential of HV to enhance treatment retention and compliance. Nicolas Bertholet, MD, MSc

Reference:

Moraes E, Campos GM, Figlie NB, et al. Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence. Eur Addict Res. 2010;16(2):69–77.Alcohol, Other Drugs, and Health: Current Evidence