Nalpas B, Combescure C, Pierre B, Ledent T, Gillet C, Playoust D, Danel T, Bozonnat M C, Martin S, Balmès J L, Daurès J P
Service d'Hépatogastroentérologie et Alcoologie, Centre Hospitalier Universitaire, Caremeau, Nìmes, France.
Alcohol Clin Exp Res. 2003 Jan;27(1):51-6. doi: 10.1097/01.ALC.0000047301.72437.10.
Alcoholism is a worldwide problem. Many strategies for alcohol detoxification and relapse prevention exist, but each alcohol treatment center has its own program. The objective of this study was to analyze and compare the financial cost and effectiveness of alcohol treatment programs from inpatient stay to follow-up 1 year later. This was a prospective, open, nonrandomized study of 4 specialized alcohol treatment centers and 267 patients admitted for alcohol detoxification.
We recorded all medical and nonmedical interventions related to the program during patient stay in the hospital and every 3 months after discharge for 1 year and recorded the occurrence of alcohol relapse. Financial evaluation was based on the prices of refund from the French national health insurance service.
The mean cost of hospitalization ranged from 1326 euros to 1917 euros(p = 0.001), a variation mainly due to the difference in the length of hospital stay but also to the cost of the inpatient program, routine medical checkups, and drugs administered. The mean cost of 1 year of follow-up per patient ranged from 419 euros to 1704 euros (p = 0.001). The efficiency, corresponding to the money spent to prevent the relapse of one patient during 1 month, was approximately 500 euros/month in three centers and 658 euros in the fourth. However, for a similar efficiency, the effectiveness, assessed by the mean time without relapse, was significantly (p = 0.001) different; center 1, which had the highest total cost, had an effectiveness 1.56 times higher than center 3, which had the lowest cost.
This work emphasizes the heterogeneity of the costs and effectiveness of alcoholism treatment programs and suggests that research should be conducted to determine which program is the most rational, cost-efficient, and beneficial for patients and the public health office economy.
酗酒是一个全球性问题。存在许多戒酒和预防复发的策略，但每个酒精治疗中心都有自己的方案。本研究的目的是分析和比较从住院到1年后随访期间酒精治疗方案的财务成本和效果。这是一项对4个专业酒精治疗中心和267名因酒精戒断入院的患者进行的前瞻性、开放性、非随机研究。
我们记录了患者住院期间以及出院后每3个月为期1年的与该方案相关的所有医疗和非医疗干预措施，并记录了酒精复发的情况。财务评估基于法国国家医疗保险服务的退款价格。
住院的平均费用在1326欧元至1917欧元之间（p = 0.001），这种差异主要是由于住院时间的不同，也与住院方案、常规体检和所使用药物的费用有关。每位患者1年随访的平均费用在419欧元至1704欧元之间（p = 0.001）。效率，即防止一名患者在1个月内复发所花费的金钱，在三个中心约为500欧元/月，在第四个中心为658欧元。然而，对于类似的效率，通过无复发平均时间评估的效果却有显著差异（p = 0.001）；总成本最高的中心1的效果比成本最低的中心3高1.56倍。
这项工作强调了酒精中毒治疗方案在成本和效果方面的异质性，并建议应进行研究以确定哪种方案对患者和公共卫生办公室经济来说最合理且成本效益最高、最有益。
