Healthcare usage and cost-effectiveness of approach bias modification at 12-months for patients undergoing inpatient withdrawal for alcohol use disorder
Year: 2025
Type: article
Abstract: INTRODUCTION: There is evidence that approach bias modification (ApBM), a type of computerised cognitive training delivered during inpatient alcohol withdrawal treatment, significantly reduces relapse rate. Our analysis examines, for the first time, whether ApBM is cost-effective compared to sham-trained controls. METHODS: Patients at four inpatient withdrawal units were randomized to four daily sessions of ApBM, or sham (control) training. Self-reported data on alcohol use, treatment, and healthcare use was collected over 12-months. We conducted a trial-based cost-effectiveness study of ApBM (versus no ApBM) from a health system perspective. Costs were from relevant Australian 2022 sources. We estimated incremental differences between groups in healthcare costs and abstinence rates using mixed generalised linear models. RESULTS: At 12 months after discharge from the index withdrawal treatment episode, two thirds of participants had accessed acute health care services (i.e., inpatient withdrawal, ambulance, emergency department and hospital inpatient). Results generally indicated non-significant increases in cumulative costs ($6747, 95%CI: -$7743, $21,237; p = .361) at 12 months for the ApBM group versus controls. The incremental cost of ApBM versus no intervention for 12 months of continuous abstinence was $201,610, with confidence limits ranging from ApBM being less costly and more effective to more costly and less effective than no ApBM. CONCLUSION: Although there was evidence of improved abstinence rates in the first 3-months post-discharge, delivering ApBM during acute alcohol withdrawal treatment will not likely generate net benefits over a 1-year period at any willingness-to-pay threshold, due to the continued heavy use of healthcare services in this population. Future research should test whether additional ApBM delivered post-discharge (e.g., via smartphone apps) could extend its relapse prevention effects and ultimately result in cost savings in the long-term.
Institutions: Monash University, Eastern Health, Deakin University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,440
OpenAlex ID: W4416719903