COST EFFECTIVENESS OF ALCOHOL TREATMENT

酗酒和吸毒给社会造成巨大代价。 1992年，酗酒和吸毒造成的经济损失估计为2460亿美元。 其中大部分费用来自酗酒（1480亿美元）。 部分是为了应对这些成本，最近开发了新的药物疗法来治疗酒精滥用和酒精中毒。 同样，在开发旨在治疗酗酒的行为干预方面也取得了重要进展。虽然在过去几年中已经开发了新的酒精滥用疗法，但压力一直在发展，以确定不仅有效而且具有成本效益的疗法。这种压力在很大程度上是由管理式医疗驱动的，管理式医疗重视经济研究，评估新药物和行为疗法的临床和经济结果是否证明其成本合理。为了增加对两种药物治疗（纳洛酮和阿坎酸）和心理治疗的疗效的理解，国家酒精滥用和酒精中毒研究所（NIAAA）最近资助了一项多地点随机对照试验（RCT）。这项试验是有史以来最雄心勃勃的治疗酒精中毒的临床试验之一。 然而，尽管临床试验的经济分析很重要，但项目联合收割机方案不包括成本或成本效益研究。 本研究的目的是检查成本和成本效益的行为和药物治疗酒精中毒（及其组合）包括在项目组合。 我们提出的项目建立在Project联合收割机的RCT设计基础上，这将为我们的结果在科学界提供很大的可信度。 由于研究的治疗方法的数量，研究设计的强度，以及酒精治疗的成本和成本效益的有限现有文献，拟议的研究代表了酒精治疗的成本和成本效益分析的重大进展;我们的结果应该对美国酒精治疗的选择产生深远的影响。

Alcohol and drug abuse impose significant costs on society. In 1992, the economic cost of alcohol and drug abuse was estimated to be 246 billion dollars. The majority of these costs arise from alcohol abuse (148 billion dollars). Partly in response to these costs, new pharmacotherapies have recently been developed to treat alcohol abuse and alcoholism. Likewise, important advances have been made in the development of behavioral interventions designed to treat alcohol abuse. While new alcohol abuse therapies have been developed over the last several years, pressures have been developing to identify therapies that are not only efficacious but also cost-effective. Much of this pressure has been driven by managed care, which has placed a premium on economic studies that assess whether the clinical and economic outcomes of new pharmaceutical and behavioral therapies justify their costs. To increase the understanding of the efficacy of two pharmacotherapies (naltrexone and acamprosate) and psychotherapy, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recently funded Project COMBINE, a multi-site, randomized control trial (RCT). This trial is one of the most ambitious clinical trials ever undertaken for the treatment of alcoholism. However, in spite of the importance of economic analysis of clinical trials, the Project COMBINE protocol does not include cost or cost-effectiveness studies. The purpose of this study is to examine the costs and cost-effectiveness of behavioral and pharmacotherapies for alcoholism (and their combination) included in Project COMBINE. Our proposed project builds on Project COMBINE's RCT design, which will provide great credibility of our results in the scientific community. Because of the number of therapies studied, the strength of the study design, and the limited existing literature on the cost and cost-effectiveness of alcohol treatments, the proposed study represents a major advance in the cost and cost-effectiveness analysis of alcohol treatment; our results should have a profound effect on the choice of alcohol treatment in the United States.