Send email for updates


About updates
Research analysis

This entry is our analysis of a study added to the Effectiveness Bank. The original study was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text The Summary conveys the findings and views expressed in the study. Below is a commentary from Drug and Alcohol Findings.

Title and link for copying Comment/query to editor

Cost-effectiveness of home visits in the outpatient treatment of patients with alcohol dependence.

Moraes E, Campos G.M., Figlie N.B. et al.
European Addiction Research: 2010, 16, p. 69–77.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Moraes at nanemoraes@uol.com.br.

In Brazil adding home visits to a three-month alcohol detoxification and treatment programme cost-effectively increased the abstinence rate at the end of treatment.

Summary The featured report is a cost-effectiveness analysis based on a study conducted in the mid-2000s in Brazil comparing outpatient alcohol treatment with versus without additional home visits. In the trial 120 alcoholic patients starting outpatient treatment at a clinic in São Paulo were allocated to a multidisciplinary unit devised for the study. It offered a standard three-month treatment programme of detoxification plus 20 group therapy sessions based on relapse prevention techniques and motivational interviewing. A randomly selected half of the patients were also offered four home visits beginning at the start of the treatment and then weekly, during which therapists used motivational interviewing principles and techniques to enhance the patient's and family's adherence to treatment.

Main findings

The main criterion of successful treatment – abstinence during what was intended to be the last month of treatment – was achieved by 43% of patients not offered home visits and 58% offered these visits, a substantial but not statistically significant difference, so one subject to considerable uncertainty. Taking in to account the treatment itself, other medical costs, and productivity losses, the costs associated with outpatient treatment amounted to 602 Brazilian Real per patient; with home visits, costs increased to 819 Brazilian Real per patient. However, home visits led to more patients achieving abstinence. Per extra abstinent patient, the extra cost associated with home visits was 4260 Brazilian Real or 1852 US dollars, though this figure varied considerably when different assumptions were made about the success rates of the treatments.

The authors' conclusions

According to the yardstick adopted by the World Health Organization, the extra abstinence rate gained by home visits means these count as a cost-effective health intervention, and the extra costs are highly likely to be outweighed by social cost savings.


Findings logo commentary The structured nature, explicitly motivational approach, and clear objectives of the home visits in this study may have been critical to their achieving a greater abstinence rate. In one British study (details below), how visits were done made the difference between practically no patients controlling their drinking 12 months later versus a substantial minority.

A British study has suggested that what happens during home visits has a major impact on sustained success after detoxification. In this study half the patients were randomly allocated to standard home detoxification consisting of five home visits by a community psychiatric nurse who gave medication and advice to help control withdrawal symptoms and reduce discomfort. The other half were allocated to the same procedure over the same time periods conducted by the same staff, except that the advice element was structured via a manual into three phases. The first session adopted a non-confrontational style aimed at building rapport and motivation. The next two aimed to help the patient manage and accept discomfort and to develop and practice specific relapse prevention skills. The last two aimed to engage the patient's friends and family in supporting their recovery and developing new social activities.

Researchers interviewed patients three (92% contacted) and twelve (86% contacted) months after the detoxification and the results were compared with pre-treatment assessments. On every measure of drinking including abstinence and amount overall or per drinking day, patients given structured counselling had made greater reductions. In the three months before the 12-month follow-up, just three out of 40 standard detoxification patients were abstinent or drinking at relatively safe levels compared to 15 out of 38 given structured counselling. The latter also experienced greater reductions in alcohol-related problems and improved social satisfaction and self-esteem. Cost estimates suggest that even accounting for the training required, the home detoxification programme was a ninth the cost of an inpatient detoxification and under half the cost of an outpatient procedure.

Thanks for their comments on this entry in draft to Edilaine Moraes of the Federal University of São Paulo. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 24 January 2012

Comment/query to editor
Give us your feedback on the site (one-minute survey)
Open Effectiveness Bank home page
Add your name to the mailing list to be alerted to new studies and other site updates


Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2005 Structured nursing advice helps alcohol home detox patients keep staying sober

STUDY 2011 Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness

REVIEW 2011 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

STUDY 2009 Randomized controlled trial of a cognitive-behavioral motivational intervention in a group versus individual format for substance use disorders

STUDY 2006 UK trial bolsters case for well-supervised alcohol therapy

STUDY 2001 Brief motivational therapy minimises health care costs except among more problematic drinkers

STUDY 2008 Still hard to find reasons for matching patients to therapies

STUDY 2004 Dual diagnosis add-on to mental health services improves outcomes

STUDY 2002 Group cognitive-behavioural therapy can work well and save money

STUDY 2010 Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes