Quelch Darren, Granger Rachel, Lloyd-Williams Huw, Copland Arlene, Roderique-Davies Gareth, John Bev, Edwards Rhiannon Tudor
Addictions Research Group, Applied Psychology Research and Innovation Group, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
Alcohol Care and Clinical Toxicology Team, Sandwell and West-Birmingham Hospital NHS Trust, City Hospital, Birmingham, UK.
Drug Alcohol Rev. 2025 May;44(4):990-1009. doi: 10.1111/dar.14053. Epub 2025 Apr 14.
Alcohol withdrawal syndrome (AWS) is a medical emergency associated with lengthy hospital stays and an increased frequency of alcohol-related hospital admissions. Rising numbers of alcohol-related health presentations and limited resources of alcohol treatment services necessitate the implementation of both cost-effective and clinically effective interventions.
A systematic literature search was conducted to review the economic evidence base for AWS interventions. A search of PubMed, Medline, Embase, Web-of-Science and Proquest identified 6347 articles. Following duplicate removal, 5250 English language papers were screened; 58 papers met eligibility criteria. Fifty papers were excluded at full-text screening; 8 papers were included. A novel logic model describing factors impacting clinical and cost-effectiveness of AWS management was developed.
The United States (3), the United Kingdom (3), France (1) and Switzerland (1) based studies took primarily a health sector perspective, with most reporting on cost savings, rather than full health economic evaluations. Both patient- or symptom-specific guidelines and outpatient treatment reduce service costs in select patient populations, without impacting on treatment outcomes. Additional psychological outpatient support may also be a cost-effective addition to treatment.
Where clinically suitable, early transition of AWS treatment to outpatient settings, alongside implementation of patient- or symptom-specific treatment guidelines, both may improve the cost-effectiveness of alcohol treatment services. Significant heterogeneity among current study methodology, patient population and poor-quality economic evidence means further studies are required.
To develop a more robust understanding of cost and clinical-effectiveness, we propose a transdisciplinary research agenda between health economics, academic expertise and AWS services to address the current evidence gap in this area.
酒精戒断综合征（AWS）是一种医疗急症，与住院时间延长及酒精相关住院次数增加有关。与酒精相关的健康问题就诊人数不断上升，而酒精治疗服务资源有限，因此有必要实施具有成本效益和临床效果的干预措施。
进行了系统的文献检索，以回顾AWS干预措施的经济证据基础。对PubMed、Medline、Embase、科学网和ProQuest进行检索，共识别出6347篇文章。在去除重复文章后，筛选了5250篇英文论文；58篇符合入选标准。在全文筛选中排除了50篇论文；纳入了8篇论文。开发了一种新颖的逻辑模型，描述影响AWS管理临床和成本效益的因素。
美国（3项）、英国（3项）、法国（1项）和瑞士（1项）的研究主要从卫生部门的角度进行，大多数报告的是成本节约情况，而非全面的卫生经济评估。针对特定患者或症状的指南以及门诊治疗在特定患者群体中可降低服务成本，且不影响治疗效果。额外的心理门诊支持也可能是一种具有成本效益的治疗补充。
在临床合适的情况下，将AWS治疗尽早过渡到门诊环境，同时实施针对特定患者或症状的治疗指南，两者都可能提高酒精治疗服务的成本效益。当前研究方法、患者群体之间存在显著异质性，且经济证据质量较差，这意味着需要进一步开展研究。
为了更深入地理解成本和临床效果，我们提议在卫生经济学、学术专业知识和AWS服务之间建立一个跨学科研究议程，以解决该领域目前的证据空白。
