Doran Christopher M
National Drug and Alcohol Research Centre , University of New South Wales, Sydney, Australia.
Pharmacoeconomics. 2008;26(5):371-93. doi: 10.2165/00019053-200826050-00003.
Opiate dependence imposes a significant economic burden on society in terms of treatment-related costs and prevention services, other healthcare costs, the work absenteeism of patients, productivity loss arising from premature death of patients, costs associated with crime, and social welfare expenditure. The objective of this research is to review the literature on economic evaluation of treatment of opiate dependence (including detoxification, maintenance and psychosocial support).A literature review was performed on several electronic databases, including MEDLINE (Ovid), Cochrane Database of Systematic Reviews, NHS Economic Evaluation Library Database (via Cochrane Library), Web of Science, Social Science Citations Index, EMBASE and PsycINFO. A sensitive approach was used in order to maximize the number of articles retrieved; no language or publication year limitations were applied to the searches. A combination of subject heading term searches and natural word searches were used. The Drummond checklist was applied to assess the quality of economic evaluations.A total of 259 articles were considered relevant, with eight review studies identified. The treatment spectrum ranged from detoxification to maintenance treatments involving the use of agonist and/or antagonist treatments. The evidence suggests that, although the quality of economic evaluations is reasonably good, there is a dearth of knowledge about the cost effectiveness of treatments for opiate dependence. The majority of the literature reporting the results of cost-effectiveness analyses used surrogate outcome measures and adopted a narrow treatment provider perspective. Studies that have conducted cost-benefit analyses, in spite of methodological divergences, generally adopted a societal perspective and consistently demonstrated positive economic returns from opiate treatment. A paucity of research examined the extent to which psychosocial or behavioural interventions support or replace conventional pharmacological approaches. Economic evaluation provides a useful framework to assist policy makers in allocating resources across competing needs. Opiate dependence is a considerable burden on society's resources, and treatment provides a cost-beneficial solution to address these consequences. However, to better inform the decision-making process, researchers must continue to produce high-quality, methodological, comparable and scientifically credible economic evaluations.
阿片类药物依赖在治疗相关成本和预防服务、其他医疗保健成本、患者旷工、患者过早死亡导致的生产力损失、与犯罪相关的成本以及社会福利支出等方面给社会带来了巨大的经济负担。本研究的目的是回顾关于阿片类药物依赖治疗的经济评估（包括戒毒、维持治疗和心理社会支持）的文献。
对多个电子数据库进行了文献综述，包括MEDLINE（Ovid）、Cochrane系统评价数据库、NHS经济评估图书馆数据库（通过Cochrane图书馆）、科学引文索引、社会科学引文索引、EMBASE和PsycINFO。采用了一种敏感的方法以最大限度地检索文章数量；搜索未设语言或出版年份限制。使用了主题词搜索和自然词搜索相结合的方式。应用Drummond清单来评估经济评估的质量。
总共259篇文章被认为相关，其中识别出8项综述研究。治疗范围从戒毒到涉及使用激动剂和/或拮抗剂治疗的维持治疗。证据表明，尽管经济评估的质量相当不错，但对于阿片类药物依赖治疗的成本效益缺乏了解。大多数报告成本效益分析结果的文献使用了替代结局指标，并采用了狭义的治疗提供者视角。尽管方法存在差异，但进行成本效益分析的研究通常采用社会视角，并一致表明阿片类药物治疗具有积极的经济回报。很少有研究考察心理社会或行为干预在多大程度上支持或替代传统药理学方法。经济评估提供了一个有用的框架，以协助政策制定者在相互竞争的需求之间分配资源。阿片类药物依赖是对社会资源的巨大负担，而治疗为解决这些后果提供了具有成本效益的解决方案。然而，为了更好地为决策过程提供信息，研究人员必须继续开展高质量、方法合理、可比且科学可信的经济评估。
