重新审视 COMBINE 研究在酒精依赖患者中的成本效益：患者视角。
Revisiting the cost-effectiveness of the COMBINE study for alcohol dependent patients: the patient perspective.
机构信息
RTI International, Research Triangle Park, NC, USA.
出版信息
Med Care. 2010 Apr;48(4):306-13. doi: 10.1097/mlr.0b013e3181ca3d40.
OBJECTIVE
Most cost and cost-effectiveness studies of substance abuse treatments focus on the costs to the provider/payer. Although this perspective is important, the costs incurred by patients should also be considered when evaluating treatment. This article presents estimates of patients' costs associated with the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) alcohol treatments and evaluates the treatments' cost-effectiveness from the patient perspective.
STUDY DESIGN
A prospective cost-effectiveness study of patients in COMBINE, a randomized controlled clinical trial of 9 alternative alcohol treatment regimens involving 1383 patients with diagnoses of primary alcohol dependence across 11 US clinic sites. We followed a microcosting approach that allowed estimation of patients' costs for specific COMBINE treatment activities. The primary clinical outcomes from COMBINE are used as indicators of treatment effectiveness.
RESULTS
The average total patient time devoted to treatment ranged from about 30 hours to 46 hours. Time spent traveling to and from treatment sessions and participation in self-help meetings accounted for the largest portion of patient time costs. The cost-effectiveness results indicate that 6 of the 9 treatments were economically dominated and only 3 treatments are potentially cost-effective depending on patient's willingness to pay for the considered outcomes: medical management (MM) + placebo, MM + naltrexone, and MM + naltrexone + acamprosate.
CONCLUSIONS
Few studies consider the patient's perspective in estimating costs and cost-effectiveness even though these costs may have a substantial impact on a patient's treatment choice, ability to access treatment, or treatment adherence. For this study, the choice of the most cost-effective treatment depends on the value placed on the outcomes by the patient, and the conclusions drawn by the patient may differ from that of the provider/payer.
目的
大多数药物滥用治疗的成本和成本效益研究都侧重于提供者/付款人的成本。尽管这种观点很重要，但在评估治疗时也应考虑患者所承担的成本。本文介绍了与联合药物治疗和行为干预（COMBINE）酒精治疗相关的患者成本估计，并从患者角度评估了治疗的成本效益。
研究设计
对 COMBINE 中的患者进行前瞻性成本效益研究，COMBINE 是一项针对 1383 名原发性酒精依赖患者的 9 种替代酒精治疗方案的随机对照临床试验，涉及美国 11 个临床站点。我们采用微观成本核算方法，能够估算患者特定 COMBINE 治疗活动的成本。COMBINE 的主要临床结果被用作治疗效果的指标。
结果
患者用于治疗的平均总时间从约 30 小时到 46 小时不等。往返治疗和参加自助会议所花费的时间占患者时间成本的最大部分。成本效益结果表明，9 种治疗方法中有 6 种在经济上处于劣势，只有 3 种治疗方法具有潜在的成本效益，具体取决于患者对所考虑结果的支付意愿：药物管理（MM）+安慰剂、MM+纳曲酮和 MM+纳曲酮+安非他酮。
结论
即使这些成本可能对患者的治疗选择、获得治疗的能力或治疗依从性产生重大影响，也很少有研究从患者角度估算成本和成本效益。对于这项研究，最具成本效益的治疗方法的选择取决于患者对结果的重视程度，并且患者得出的结论可能与提供者/付款人不同。
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