ABSTRACT
AIMS: Psychosocial approaches are the hallmark of treatment for harmful alcohol use. However, the most effective psychosocial intervention has not been identified. We aimed to compare the effectiveness of psychosocial therapy for harmful alcohol use using a network meta-analysis approach. METHODS: We searched PubMed, Embase, CENTRAL, CINAHL and ProQuest Dissertations and Theses from inception to January 2022. Randomized controlled trials in adults aged > 18 years with harmful alcohol use were included. Psychosocial interventions were classified using the theme, intensity, and provider/platform (TIP) framework. The mean differences (MD) of the alcohol use disorder identification test (AUDIT) score were estimated in the primary analysis using a random-effects model. Surface under the cumulative ranking curve (SUCRA) methods were used to rank different interventions. The certainty of evidence was evaluated using the confidence in network meta-analysis (CINeMA) approach. This review was registered with PROSPERO (CRD42022328972). RESULTS: A total of 4225 records were retrieved from searches; 19 trials (n = 7149) met the inclusion criteria. The most common TIP combination was brief interventions delivered once via face-to-face sessions (six studies) and 11 TIP features were included in the network meta-analysis. A significant difference in AUDIT score was evident among 16 of 55 treatment comparisons, with the highest effect size observed when motivational interviewing plus cognitive behavioral therapy in multiple sessions via face-to-face (MI-CBT/Mult/F2F) was compared with usual care [MD = -4.98; 95% confidence interval (CI) = -7.04, -2.91]. This finding was consistent with SUCRA, which suggested that MI-CBT/Mult/F2F is most likely to be better than other interventions (SUCRA = 91.3). MI-CBT/Mult/F2F remained the highest-ranking intervention in our sensitivity analyses (SUCRA = 64.9, 80.8). However, the certainty of evidence for most treatment comparisons was low. CONCLUSIONS: Combined psychosocial intervention with a more intensive approach may provide greater effect in reducing harmful alcohol consumption behavior.
Subject(s)
Alcoholism , Cognitive Behavioral Therapy , Substance-Related Disorders , Adult , Humans , Psychotherapy/methods , Psychosocial Intervention , Network Meta-Analysis , Substance-Related Disorders/therapyABSTRACT
OBJECTIVES: This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma. METHODS: We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6-11 years). Heterogeneity was assessed using the I2 statistic. RESULTS: A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP (n = 8, INB, -6,341 (95% CI, -$25,000 to $12,210), I2=86.18%) and SP (n = 5, -$14,000 (-$170,000 to $140,000), I2=75.64%). A similar finding was observed in those aged 6-11 years from the HCPP in LMICs (n = 2, -$45,000 (-$73,000 to $17,000), I2=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity. CONCLUSION: The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.
