Economic Evaluation of Drug Abuse Treatment and HIV Prevention Services for Pregn

说明(由申请者提供)：对孕妇的药物滥用治疗和艾滋病毒预防服务进行经济评估，对于确定最有效和公平地使用稀缺资源至关重要。有必要对妇女、青少年和少数群体成员等弱势群体的药物滥用治疗和艾滋病毒预防服务的效率进行经济和政策研究，以改善对这些弱势和未得到充分服务的群体的药物滥用和艾滋病毒/艾滋病服务。虽然这一领域的工作继续增长，但对此类项目仍然缺乏严格的经济评估，特别是那些遵守美国卫生与医学成本效益小组建议的质量标准的项目。这项研究的总体目标是对一种创新的行为方法进行首次经济评估，该方法将动机增强疗法与认知行为疗法(MET-CBT)与产前护理中的标准简短建议(BA)相比较，以减少各种物质(如大麻、可卡因、甲基苯丙胺、酒精、尼古丁)的使用，减少艾滋病毒风险行为，并实现更好的婴儿健康结局(如更长的孕期、更大的出生体重、减少入院和在新生儿重症监护病房(NICU)的住院时间等医疗后果)。这项研究的具体目的是：(1)进行MET-CBT和BA干预措施的成本分析；(2)从物质使用、婴儿健康结局和艾滋病毒风险降低方面对这两种干预措施(MET-CBT和BA)进行增量成本效益分析；以及(3)进行增量成本-效用分析，确定每个干预措施(MET-CBT和BA)在物质使用和艾滋病毒风险降低方面各自节省的每质量调整寿命年(QALY)的净成本。拟议的研究是对PA-07-122的回应，因为它提议进行与成本效益和成本效益分析、服务成本、方法研究以及艾滋病毒/艾滋病和健康差距等跨领域主题有关的研究。这项拟议的研究基于美国健康与医学成本效益小组报告的健全的微观经济学原则和标准化技术，并建议进行严格的概念和方法研究，以改进药物滥用治疗和艾滋病毒预防服务的单位成本和成本效益的证据基础。它建立在NIDA资助的创新行为方法的随机对照试验(R01-DA019135)的基础上，提供了一种新的治疗服务范式，与标准BA相比，将MET-CBT整合到产前护理中，并承诺改善和加强针对使用药物的孕妇的药物使用治疗和艾滋病毒预防服务，这些孕妇对艾滋病毒/艾滋病高度敏感。 公共卫生相关性：怀孕期间的药物滥用和高危艾滋病毒行为是美国的主要公共卫生问题，因为它们对个人吸毒者、他们的后代和周围社区产生影响。针对孕妇的药物滥用和艾滋病毒预防方案具有潜在的成本效益，因为这样可以减少低出生体重婴儿和围产期死亡，减少婴儿期和儿童期的身体、认知和行为问题，并可为母亲带来显著的健康益处。这项研究的总体目标是对一种创新的行为方法进行首次经济评估，该方法将动机增强疗法与认知行为疗法(MET-CBT)与产前护理中的标准简短建议(BA)相比较，以减少各种物质(如大麻、可卡因、甲基苯丙胺、酒精、尼古丁)的使用，减少艾滋病毒风险行为，并实现更好的婴儿健康结局(如更长的孕期、更大的出生体重、减少入院和在新生儿重症监护病房(NICU)的住院时间等医疗后果)。

DESCRIPTION (provided by applicant): Economic evaluation of drug abuse treatment and HIV prevention services for pregnant women is critical to identify the most efficient and equitable use of scarce resources. Economic and policy research on the efficiency of drug abuse treatment and HIV prevention services among vulnerable populations such as women, adolescents and members of minority groups is necessary to improve drug abuse and HIV/AIDS services for these vulnerable and underserved populations. While work in this area continues to grow, there is still a dearth of rigorous economic evaluations of such programs, especially those that adhere to quality standards as recommended by the U.S. Panel on Cost Effectiveness in Health and Medicine. The overall objective of this study is to conduct the first economic evaluation of an innovative behavioral approach integrating Motivational Enhancement Therapy with Cognitive Behavioral Therapy (MET-CBT) as compared to standard Brief Advice (BA) within prenatal care to decrease use of a full range of substances (e.g., marijuana, cocaine, methamphetamines, alcohol, nicotine), to reduce HIV risk behavior and to achieve better infant health outcomes (e.g. longer gestations, greater birth weight, reduced medical consequences such as admission and length of stay in the Neonatal Intensive Care Unit (NICU)). The specific aims of this study are: (1) to conduct cost analyses of the MET-CBT and BA intervention arms; (2) to conduct incremental cost-effectiveness analyses of the two interventions (MET-CBT and BA), vis-`-vis each other, in terms of substance use, infant health outcomes and HIV risk reduction; and (3) to conduct incremental cost-utility analyses determining the net cost per Quality-Adjusted Life Year (QALY) saved respectively by each intervention arm (MET-CBT and BA), vis-`-vis each other, in terms of substance use and HIV risk reduction. The proposed research is responsive to PA-07-122 in that it proposes to conduct research related to cost-effectiveness and cost-utility analyses, services costs, methodological research, and the cross-cutting themes of HIV/AIDS and health disparities. The proposed research is grounded in sound microeconomic principles and standardized techniques as reported in the U.S. Panel on Cost Effectiveness in Health and Medicine, and proposes rigorous conceptual and methodological research to improve the evidence base on the unit costs and cost-effectiveness of substance abuse treatment and HIV prevention services. It builds on a NIDA-funded randomized controlled trial (R01-DA019135) of an innovate behavioral approach, which offers a new paradigm of treatment services, integrating MET-CBT within prenatal care compared to standard BA, and offering promise to improve access to and strengthen substance use treatment and HIV prevention services targeted at drug using pregnant women who are highly susceptible to HIV/AIDS. PUBLIC HEALTH RELEVANCE: Drug abuse and high risk HIV behavior during pregnancy are major public health problems in the United States due to their impact on individual users, their offspring, and surrounding communities. Drug abuse and HIV prevention programs targeting pregnant women have the potential to be cost-effective due to the resultant fewer low-birth-weight babies and perinatal deaths, fewer physical, cognitive and behavioral problems during infancy and childhood, and the significant health benefits that can accrue to the mother. The overall objective of this study is to conduct the first economic evaluation of an innovative behavioral approach integrating Motivational Enhancement Therapy with Cognitive Behavioral Therapy (MET-CBT) as compared to standard Brief Advice (BA) within prenatal care to decrease use of a full range of substances (e.g., marijuana, cocaine, methamphetamines, alcohol, nicotine), to reduce HIV risk behavior and to achieve better infant health outcomes (e.g. longer gestations, greater birth weight, reduced medical consequences such as admission and length of stay in the Neonatal Intensive Care Unit (NICU)).