A systematic review of the economic evidence surrounding the management of alcohol withdrawal

Issues: 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. Approach: 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. Key Findings: 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. Implications: 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. Conclusion: 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.