Jeremy Bray, PhD, department head, professor of economics, and newly-appointed Jefferson-Pilot Excellence Professor, received notice of a significant research grant of $436,371 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for his research project “Alcohol consumption and related comorbid conditions: health state utilities for economic evaluation.”
Bray is an internationally-recognized authority on the economics of risky health behaviors and the economic evaluation of behavioral health interventions, including workplace substance abuse prevention programs and alcohol screening and brief interventions for at-risk drinking. Before joining UNC Greensboro, he served nine years as program director for the national cross-site evaluation of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program funded by the U.S. Substance Abuse and Mental Health Services Administration.
An expert in the field, Bray was recently interviewed by Wisconsin Public Radio about the high economic and social cost of excessive drinking. Bray is eager to understand more deeply the public health implications in the arena of alcohol consumption and related overlapping health conditions, also known as comorbid conditions or joint health states.
Through his new study, Bray will conduct rigorous alcohol health services research to inform practice and policy. This research will parallel medically-focused health services research to establish a ‘level the playing field’ in the world of public health and the distribution of health resources by comparing the benefits of addressing joint health states with alcohol misuse to other interventions, such as cancer screenings and flu shots.
Health State Utility Scores Reveal Benefits of New Interventions
New approaches to dealing with alcohol misuse, such as SBIRT, attempt to identify and address alcohol misuse in a primary care setting, like a doctor’s office. In this approach, a patient receives a questionnaire or a verbal interview about how much, how often, and in what context he or she uses alcohol. Based on the answers, the doctor then delivers an appropriate intervention. For example, a low score will receive little to no intervention, while a middle-range score receives a brief intervention whereby the doctor encourages the patient to cut back on alcohol consumption. A much higher score will result in a referral to formal treatment. Because this approach addresses alcohol use before people realize that it might be causing problems, it is important that policymakers understand the value people put on addressing alcohol relative to other issues they might be facing. This is where health state utilities (HSUs) some into play. HSUs reflect an individual’s preferences for health and so let policymaker assess individuals’ preferences for addressing health issues across a wide range of concerns.
Dr. Bray’s new study will mine HSU data from The National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a large, nationally representative database, in order to numerically synthesize the data and examine a common metric.
“The aims of our study are to analyze the health utilities data in order to advance the methodological approach to estimate health states related to people identified with alcohol misuse / abuse. Very few people have just one issue – especially with alcohol. Some people use alcohol to self-medicate for conditions such as depression, or have medical conditions related to alcohol use, such as diabetes – these are joint health states. Our research seeks to understand the impact of joint health states related to alcohol with regard to the HSU, which is something that has not yet been studied,” Bray said.
“One thing that led me to this research is work I did with the Harvard School of Public Health on opioid health states. I was involved in an earlier study doing this same work but around opioid use. If people are in chronic pain, they want to do something about it. There is the same issue with alcohol use.”
Quality Adjusted Life Years Reveal Perceived Life Quality
Quality Adjusted Life Years (QALY) scores are less about a doctor’s, or someone else’s perception of your quality of life – it’s about an individual’s perception of his or her own quality of life. HSUs come into play here – utility is an economic concept from microeconomic theory. It’s the satisfaction a person gets out of a good or a product, or a state of being.
From this standpoint, Bray said he wants to understand a person’s satisfaction for living in their current state of health – within the context of alcohol use / misuse and joint health states. “Someone in perfect health is at 1, and death is 0. So Every health state can be quantified numerically: if cancer has a HSU of .7, that means you like living in the state of cancer only 70% as much as you like living in perfect health. If you spend two years in perfect health, that’s 2 QALYs. But if you spend two years with cancer, that’s 1.4 QALYs.”
“Our study seeks to understand what the different health utilities are for different kinds of alcohol health states through a numerical / economic lens. If a person has a history of severe alcohol abuse but no longer drinks he or she has a different score than someone who drinks a lot but has no symptoms. Some people have received brief alcohol interventions based on their screening results, and we want to know if this was beneficial. We will look at several dimensions to discover where people land on the disorder continuum,” Bray said.
“Our research results will provide information to help us understand the benefits of interventions in the same way we understand traditional medical interventions such as cancer treatments and flu shots,” he added.
Bray is poised for the research to begin as soon as his research team is assembled.