Economic evaluation of interventions for problem drinking and alcohol dependence: do within-family external effects make a difference?
OBJECTIVE
To propose methods for the inclusion of within-family external effects in clinical and economic evaluations. To demonstrate the extent of bias due to the exclusion of within-family external effects when measuring the relative performance of interventions for problem drinking and alcohol dependence.


METHODS
The timing and magnitude of treatment effects are modified to accommodate the external health-related quality of life impact of having a problem or dependent drinker in the family home.


RESULTS
The inclusion of within-family external effects reduces cost per QALY estimates of interventions for problem drinking and alcohol dependence thereby improving the performance of all evaluated interventions. In addition, the inclusion of within-family external effects improves the relative performance of interventions targeted at those with moderate-to-severe alcohol dependence as compared to interventions targeted at less severe alcohol problems.


CONCLUSIONS
Failure to take account of external effects in clinical and economic evaluations results in an uneven playing field. Interventions with readily quantifiable health benefits (where social costs and benefits are predominantly comprised of private costs and benefits) are at a distinct advantage when competing for public funding against interventions with quantitatively important external effects.
Mortimer
Duncan
D
Centre for Health Economics, Faculty of Business and Economics, Monash University, VIC 3800, Australia. duncan.mortimer@buseco.monash.edu.au
Segal
Leonie
L
D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D003365:Costs and Cost Analysis; D004467:Economics; D005190:Family / Q000523:psychology*; D006801:Humans; D008019:Life Style; D011788:Quality of Life