COST EFFECTIVENESS OF ALCOHOL TREATMENT

酗酒和吸毒给社会带来了巨大的代价。1992年，酗酒和吸毒造成的经济损失估计为2460亿美元。这些成本中的大部分来自酗酒(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，旨在治疗酗酒的行为干预措施的开发也取得了重要进展。虽然在过去的几年里已经开发出了新的酒精滥用疗法，但人们也面临着寻找不仅有效而且成本效益高的疗法的压力。这种压力在很大程度上是由管理型医疗保健推动的，管理型医疗保健重视评估新药和行为疗法的临床和经济结果是否证明其成本合理的经济学研究。为了增加对两种药物疗法(纳曲酮和氨基己酸酯)和心理疗法的疗效的了解，美国国家酒精滥用和酒精中毒研究所(NIAAA)最近资助了一项多点随机对照试验(RCT)项目Combine。这项试验是有史以来最雄心勃勃的酒精中毒治疗临床试验之一。然而，尽管临床试验的经济分析很重要，Project Combine方案并不包括成本或成本效益研究。这项研究的目的是检查联合项目中包括的酒精中毒行为疗法和药物疗法(及其组合)的成本和成本效益。我们建议的项目建立在Project Combine的随机对照试验设计的基础上，这将为我们的结果在科学界提供极大的可信度。由于研究的疗法的数量，研究设计的强度，以及关于酒精治疗成本和成本效益的现有文献有限，拟议的研究代表着酒精治疗成本和成本效益分析的重大进步；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.