Assessing the comparative cost-effectiveness of alcoholism treatments: a comment on Holder, Longabaugh, Miller and...

Holder, Longabaugh, Miller and Rubonis (JSA, vol. 53, pp. 517-540, 1991) discuss the shortcomings of the empirical literature relevant to an assessment of the comparative cost-effectiveness of alcoholism treatment modalities. Their analysis is rooted in an attempt to conjoin the literatures pertaining to clinical efficacy and costs of alcohol dependence treatment. Holder et al.'s methodology is flawed in a number of respects and they exceed the bounds of the evidence when they endorse particular treatment modalities as comparatively cost-effective. Generalizations as to the relative cost-effectiveness of particular modalities are forwarded despite the fact that treatments are applied to persons with alcohol problems of widely varying severity. Additional points of contention are raised regarding the authors' selection of acceptable studies and interpretation of findings. Despite these limitations, Holder et al.'s (1991) analysis is a seminal heuristic contribution to the discussion of cost-effectiveness in the alcoholism field.