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

描述（由申请人提供）：对孕妇进行药物滥用治疗和艾滋病毒预防服务的经济评估对于确定最有效和公平利用稀缺资源至关重要。必须对妇女、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，以改善对这些弱势群体和服务不足人群的药物滥用和艾滋病毒/艾滋病服务。虽然这一领域的工作持续增长，但仍然缺乏对这类项目的严格经济评估，特别是那些坚持美国卫生和医学成本效益小组建议的质量标准的项目。本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（mets - cbt）结合起来，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果(如更长妊娠期、更大的出生体重、减少医疗后果，如入院和在新生儿重症监护病房（NICU）的住院时间)。本研究的具体目的是：(1)对MET-CBT和BA干预手段进行成本分析；(2)在药物使用、婴儿健康结局和降低艾滋病毒风险方面，对两种干预措施（MET-CBT和BA）进行增量成本效益分析；(3)进行增量成本效用分析，确定每个干预组（MET-CBT和BA）在物质使用和艾滋病毒风险降低方面分别节省的每个质量调整生命年（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用分析、服务费用、方法研究以及艾滋病毒/艾滋病和保健差距等交叉主题有关的研究。拟议的研究以美国卫生和医学成本效益问题小组所报告的健全的微观经济学原则和标准化技术为基础，并建议进行严格的概念和方法研究，以改进基于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。它建立在nida资助的一项创新行为方法的随机对照试验（R01-DA019135）的基础上，该试验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，并提供了改善和加强药物使用治疗和艾滋病毒预防服务的承诺，针对艾滋病毒/艾滋病易感的吸毒孕妇。

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.