The cost-effectiveness of interventions to prevent, screen, and treat alcohol liver disease systematic literature review

Abstract

Background: Daily excessive alcohol drinking is associated with an increased risk of developing Alcohol related liver diseases (ALDs), which is the most preventable form of liver disease. ALDs complications range from being simple to life-threatening, and from reversible to irreversible liver damage. Objectives: The aim of this study to evaluate the cost effectiveness of interventions to prevent, screen and treat alcoholic related liver diseases. Methods: A systematic literature review was undertaken to identify published cost effectiveness papers of the interventions to prevent, screen or treat alcoholic liver diseases. Search was performed on Medline Ovid, EMBASE Ovid, Cochrane Library, London School of Economics (LSE) Library, Google Scholar and grey literature. Due to heterogeneity of studies, a qualitative analysis was conducted. The risk of bias of the included studies was assessed using two different methodological quality appraisals; the 10‐item Drummond the BMJ checklist and the AMSTAR-2 Results: 14 full-text articles met the inclusion criteria of the study. Seven Prevention interventions articles were analyzed, the majority of the interventions were cost effective. The prevention interventions include taxation, marketing regulations, educational and informative campaigns, alcohol brief advice, minimum legal drink age, and minimum unit pricing. Seven Screening interventions articles were extracted; the cost-effectiveness of the interventions were not clear as it showed mixed result. The articles included non-invasive screening measures for different alcoholic related liver diseases, with different methods including imaging tests, blood tests, or/and both. Then, some studies compare it with an invasive method, in this case, liver biopsy. The cost effectiveness result among the studies were mixed. Two treatment interventions articles were extracted; the major finding for both studies were the effectiveness and cost effectiveness of alcohol abstaining as treatment for ALDs.

Conclusions: The results of this systematic review found that First, the evidence shows that taxation is among the most cost-effective intervention to prevent ALDs. Second, despite the mixed results in the screening interventions, the liver biopsy remains the most cost-effective method for ALDs. Last, the primary cost-effective treatment intervention identified was complete alcohol abstinence. However, there are a limited number of findings within the desired review scope. Further research into the cost-effectiveness of interventions to prevent, screen, and treat alcohol-related liver disease is critical.