Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

Essex, Holly; White, Ian R.; Khadjesari, Zarnie; Linke, Stuart; McCambridge, Jim; Murray, Elizabeth; Parrott, Steve; Godfrey, Christine

doi:10.1007/s11136-013-0521-7

Cited by 26 publications

(21 citation statements)

References 64 publications

(84 reference statements)

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“…Our findings from the economic evaluation assessing the suitability of the EQ-5D in EBI replicated findings from previous studies in adults without ID in that the EQ-5D is not correlated with the AUDIT and, hence, does not relate to levels of hazardous drinking [34]. …”

Section: Discussionsupporting

confidence: 84%

A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study

Kouimtsidis

Bosco

Scior

et al. 2017

Trials

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BackgroundExtended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. However, little is known of the effects of EBI in adults with intellectual (also known as learning) disabilities. In this feasibility trial we compared EBI with usual care for alcohol misuse in adults with mild to moderate Intellectual Disability (ID).MethodsThe study took place in three community ID networks of services in England. Participants aged 18–65 years with reported alcohol problems, a score ≥8 on the Alcohol Use Disorder Identification Test (AUDIT), and IQ <70 (+/5%CI) were recruited and were randomly allocated to either EBI (five weekly sessions and one follow-up at 8 weeks) and usual care or usual care alone. Research assistants were blind to arm allocation. Research assessments took place at baseline, 2 and 3 months. The primary outcome was reduction in alcohol consumption measured by the AUDIT. Preliminary health economic analysis was performed to investigate the costs of delivering EBI and the feasibility of a cost-effectiveness analysis in a full trial. The trial is closed.ResultsParticipants were recruited from January 2014 to August 2015. Thirty individuals were randomised (15 in each arm) and provided primary outcome data. In regard to harmful drinking, at baseline, all the participants exceeded the relevant threshold. At 8 weeks, the proportion of participants with harmful drinking had decreased to 60% for both groups, and at 12 weeks it had decreased by 66°7% and 46°7% for the intervention and the control groups, respectively. The unit cost for the delivery of EBI is £430.ConclusionsRecruitment to this trial has been proven challenging as prevalence of alcohol misuse in the targeted population was lower than anticipated. EBI may provide an effective low-intensity treatment for this population. Participants’ and carers’ feedback on their experience was overall positive. Further work needs to be undertaken to ascertain the group of participants that should be participating in a future definitive trial.Trial registrationPsychological Intervention Alcohol Misuse Learning Disability; isrctn.com, identifier:10.1186/ISRCTN58783633. Registered on 17 December 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1953-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 84%

A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study

Kouimtsidis

Bosco

Scior

et al. 2017

Trials

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“…No cost-effectiveness thresholds have been established for alcohol outcomes in India; we have conservatively assumed that this threshold is no more than the monthly wage for an unskilled worker. The absence of effect on QALYs might be viewed in the context of doubt about the capacity of standard measures such as those used in this study to capture improvements in alcohol-related quality of life 46 . A delayed effect of reduced drinking or abstinence on QALYs could also be possible and we could perhaps expect to see a differential effect between the two groups at the 12 month outcome assessment.…”

Section: Discussionmentioning

confidence: 93%

Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial

et al. 2017

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SummaryBackgroundAlthough structured psychological treatments are recommended as first-line interventions for harmful drinking, only a small fraction of people globally receive these treatments because of poor access in routine primary care. We assessed the effectiveness and cost-effectiveness of Counselling for Alcohol Problems (CAP), a brief psychological treatment delivered by lay counsellors to patients with harmful drinking attending routine primary health-care settings.MethodsIn this randomised controlled trial, we recruited male harmful drinkers defined by an Alcohol Use Disorders Identification Test (AUDIT) score of 12–19 who were aged 18–65 years from ten primary health centres in Goa, India. We excluded patients who needed emergency medical treatment or inpatient admission, who were unable to communicate clearly, and who were intoxicated at the time of screening. Participants were randomly allocated (1:1) by trained health assistants based at the primary health centres to enhanced usual care (EUC) alone or EUC combined with CAP, in randomly sized blocks of four to six, stratified by primary health centre, and allocation was concealed with use of sequential numbered opaque envelopes. Physicians providing EUC and those assessing outcomes were masked. Primary outcomes were remission (AUDIT score of <8) and mean daily alcohol consumed in the past 14 days, at 3 months. Secondary outcomes were the effect of drinking, disability score, days unable to work, suicide attempts, intimate partner violence, and resource use and costs of illness. Analyses were on an intention-to-treat basis. We used logistic regression analysis for remission and zero-inflated negative binomial regression analysis for alcohol consumption. We assessed serious adverse events in the per-protocol population. This trial is registered with the ISCRTN registry, number ISRCTN76465238.FindingsBetween Oct 28, 2013, and July 29, 2015, we enrolled and randomly allocated 377 participants (188 [50%] to the EUC plus CAP group and 190 [50%] to the EUC alone group [one of whom was subsequently excluded because of a protocol violation]), of whom 336 (89%) completed the 3 month primary outcome assessment (164 [87%] in the EUC plus CAP group and 172 [91%] in the EUC alone group). The proportion with remission (59 [36%] of 164 in the EUC plus CAP group vs 44 [26%] of 172 in the EUC alone group; adjusted prevalence ratio 1·50 [95% CI 1·09–2·07]; p=0·01) and the proportion abstinent in the past 14 days (68 [42%] vs 31 [18%]; adjusted odds ratio 3·00 [1·76–5·13]; p<0·0001) were significantly higher in the EUC plus CAP group than in the EUC alone group, but we noted no effect on mean daily alcohol consumed in the past 14 days among those who reported drinking in this period (37·0 g [SD 44·2] vs 31·0 g [27·8]; count ratio 1·08 [0·79–1·49]; p=0·62). We noted an effect on the percentage of days abstinent in the past 14 days (adjusted mean difference [AMD] 16·0% [8·1–24·1]; p<0·0001), but no effect on the percentage of days of heavy drinking (AMD −0·4% [–5·7 to 4·...

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“…There were only four conditions (7%) (i.e., alcohol dependency [23;24], schizophrenia [25], limb reconstruction [26], and hearing impairment [27]) where the EQ-5D lacked responsiveness. The other 27 conditions (48%) have limited or mixed evidence for the responsiveness of the EQ-5D.…”

Section: Resultsmentioning

confidence: 99%

“…On the contrary, if researchers do not find any change on the EQ-5D after treatment but do find significant clinical changes on the CSMs, it means that the EQ-5D is not able to detect changes that resulted from the treatments. The EQ-5D was not responsive in four conditions (alcohol dependency [23;24], schizophrenia [25], limb reconstruction [26], and hearing impairment [27]). In addition, a condition where the EQ-5D may not be responsive is hemophilia, based on the results of a study that was published after our search period [110].…”

Section: Discussionmentioning

confidence: 99%

Can The EQ-5D Detect Meaningful Change? A Systematic Review

2015

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Background The EQ-5D is one of the most frequently used generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required. Objective This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations. Methods We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions. Results Of 1,401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45%) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48%). Only four conditions (7%) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive. Conclusion The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with 5 response levels.

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Quality of life among hazardous and harmful drinkers: EQ-5D over a 1-year follow-up period

Cited by 26 publications

References 64 publications

A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study

A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study

Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial

Can The EQ-5D Detect Meaningful Change? A Systematic Review

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