COST EFFECTIVENESS OF ALCOHOL TREATMENT

酗酒和吸毒给社会带来了巨大的代价。1992年，酗酒和滥用药物的经济成本估计为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费用，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，在制定旨在治疗酗酒的行为干预措施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治疗方法，但人们一直在寻找不仅有效而且具有成本效益的治疗方法。这种压力在很大程度上是由管理式医疗造成的，这种医疗方式对评估新药和行为疗法的临床和经济效果是否值得其成本的经济研究给予了重视。为了提高对两种药物治疗（纳曲酮和阿坎普酸）和心理治疗的疗效的了解，美国国家酒精滥用和酒精中毒研究所（NIAAA）最近资助了一个多地点随机对照试验（RCT）项目COMBINE。这项试验是迄今为止为治疗酒精中毒而进行的最雄心勃勃的临床试验之一。然而，尽管临床试验的经济分析很重要，但项目联合方案不包括成本或成本效益研究。本研究的目的是检查项目组合中酒精中毒的行为和药物治疗（及其组合）的成本和成本效益。我们提出的项目建立在项目COMBINE的RCT设计上，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，以及关于酒精治疗的成本和成本效益的现有文献有限，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；我们的研究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.