Holder Harold D.
Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA.
J Ment Health Policy Econ. 1998 Mar;1(1):23-29. doi: 10.1002/(sici)1099-176x(199803)1:1<23::aid-mhp3>3.0.co;2-q.
The treatment of substance abuse is an important health service available in all industrialized countries throughout the world. Cost of treatment and its benefit or economic value is an important policy issue. Reduction in health care cost is one alternative way to measure benefits. This paper reviews a series of studies (all from the US) which address the cost-benefit question. Most studies have compared the monthly costs prior to initiation of substance abuse treatment with the costs following initiation. RESULTS FROM STUDIES OF ALCOHOLISM TREATMENT: Many studies have found that, over the time prior to alcoholism treatment initiation, total monthly health care costs increased and costs substantially increased during the 6-12 months prior to treatment. Following treatment initiation, monthly total medical care costs declined and the overall trend was downward, i.e., the slope was negative. In contrast to the use of general health care where women typically utilize more medical care than men, overall medical care costs were found to be similar. Alcoholics of different ages, however, showed distinct medical care costs, i.e., younger patients experienced greater declines in medical care costs following alcoholism treatment initiation. Inpatient treatment is most affected by alcoholism treatment. In some cases, outpatient treatment is actually increased in response to aftercare health care utilization, but at a substantially lower cost than inpatient treatment. If the alcoholism condition can be treated on an outpatient basis, then the total cost of such treatment is obviously lower and the potential for a cost-offset net effect is substantially increased. COST BENEFITS OF DRUG ABUSE TREATMENT: There have been few drug abuse treatment cost-benefit research studies. Early studies found that there was a decline in sickness and medical care utilization associated with initiation of treatment. A recent study found a substantial reduction in total health care costs following initiation of drug abuse treatment. Utilization of inpatient care and its associated costs are most affected by the absence and/or presence of treatment. SUMMARY AND CONCLUSION: This review describes the research findings from a number of cost-offset or cost-benefit studies of alcoholism and drug abuse treatment. In broad terms the findings of this research can be summarized as follows. (i) Untreated alcoholics or drug dependent persons use health care and incur costs at a rate about twice that of their age and gender cohorts. (ii) Once treatment begins, total health care utilization and costs begin to drop, reaching a level that is lower than pre-treatment initiation costs after a two- to four-year period. The conclusion is based on similar findings across different patient populations using a variety of research designs. (iii) There are no apparent gender differences in the utilization and associated costs before and after treatment initiation. (iv) There are age differences that support the value of early intervention. Younger treated substance abuse patients have pre-treatment total cost levels that are lower than pre-treatment levels for older patients. IMPLICATIONS OF HEALTH POLICY: The results of research provide consistent support for the cost benefits of substance abuse treatment. From a health policy perspective, such results are promising if the objective is to demonstrate that treatment investment can pay for all or part of its associated costs through reductions in other health care costs. One can hold a contrary position, i.e., lower future medical care costs for substance abusers could reflect denial of essential care. IMPLICATIONS FOR FURTHER RESEARCH: The studies that have addressed the potential cost offset of substance abuse treatment have been largely based upon overall or aggregate effects across all forms of substance abuse treatment. There have been no studies of the cost offset of specific treatment modalities, though this is what the next generation of studies should do
药物滥用治疗是全球所有工业化国家都能提供的一项重要医疗服务。治疗成本及其效益或经济价值是一个重要的政策问题。降低医疗保健成本是衡量效益的一种替代方法。本文回顾了一系列（均来自美国）探讨成本效益问题的研究。大多数研究比较了开始药物滥用治疗前的每月成本与开始治疗后的成本。
许多研究发现，在开始酒精中毒治疗前的一段时间里，每月总医疗保健成本不断增加，且在治疗前的6至12个月大幅上升。开始治疗后，每月总医疗保健成本下降，总体趋势是向下的，即斜率为负。与一般医疗保健的使用情况不同，女性通常比男性使用更多医疗服务，但总体医疗保健成本被发现是相似的。然而，不同年龄的酗酒者显示出截然不同的医疗保健成本，即年轻患者在开始酒精中毒治疗后医疗保健成本下降幅度更大。住院治疗受酒精中毒治疗影响最大。在某些情况下，由于后续医疗保健的使用，门诊治疗实际上有所增加，但成本远低于住院治疗。如果酒精中毒情况可以在门诊治疗，那么这种治疗的总成本显然更低，成本抵消净效应的可能性也会大幅增加。
药物滥用治疗成本效益的研究很少。早期研究发现，开始治疗后疾病和医疗服务利用率有所下降。最近一项研究发现，开始药物滥用治疗后，总医疗保健成本大幅降低。住院护理的使用及其相关成本受有无治疗的影响最大。
本综述描述了一些关于酒精中毒和药物滥用治疗的成本抵消或成本效益研究的研究结果。从广义上讲，这项研究的结果可以总结如下。（i）未接受治疗的酗酒者或药物依赖者使用医疗保健并产生成本的速度约为同年龄和性别人群的两倍。（ii）一旦开始治疗，总医疗保健利用率和成本开始下降，在两到四年后达到低于治疗开始前成本的水平。这一结论是基于使用各种研究设计的不同患者群体的类似发现得出的。（iii）开始治疗前后的利用率和相关成本没有明显的性别差异。（iv）存在年龄差异，这支持了早期干预的价值。接受治疗的年轻药物滥用患者治疗前的总成本水平低于老年患者的治疗前水平。
研究结果为药物滥用治疗的成本效益提供了一致的支持。从卫生政策的角度来看，如果目标是证明治疗投资可以通过降低其他医疗保健成本来支付其全部或部分相关成本，那么这些结果是有希望的。也可以持有相反的观点，即药物滥用者未来较低的医疗保健成本可能反映了基本医疗服务的被拒绝提供。
探讨药物滥用治疗潜在成本抵消的研究主要基于所有形式药物滥用治疗的总体或综合效果。尚未有关于特定治疗方式成本抵消的研究，不过这是下一代研究应该做的。
