Cisler R, Holder H D, Longabaugh R, Stout R L, Zweben A
Center for Addiction and Behavioral Health Research, University of Wisconsin-Milwaukee, 53201-0786, USA.
J Stud Alcohol. 1998 Sep;59(5):503-12. doi: 10.15288/jsa.1998.59.503.
As a first step in a thorough cost-effectiveness analysis of a randomized alcohol-treatment-matching trial (Project MATCH), the present study examines the relative costs of three manual-guided, individually delivered treatments and the costs of replicating them in nonresearch settings.
Costs of delivering a 12-session Cognitive Behavioral Therapy (CBT), a 4-session Motivational Enhancement Therapy (MET) and a 12- session Twelve-Step Facilitation (TSF) treatment over 12 weeks were assessed for three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI, and Providence, RI). Research cost calculations included clinical, administrative and training/supervision variables in determining total treatment costs, average cost per contact hour and average cost per research participant. Investigators from all nine MATCH locations estimated direct clinical costs, administrative overhead costs and training/supervision costs for replicating these treatments.
For Project MATCH, MET cost twice as much or more per patient contact hour (mean = $498) than CBT (mean = $198) and TSF (mean = $253) but was less costly per research participant (mean = $1,700) than both CBT (mean = $1,901) and TSF (mean = $1,969). For clinical replication, high end per patient costs ranged from $512 for MET to $750 for TSF to $788 for CBT: a cost savings for MET of $238 (32%) over TSF and $276 (35%) over CBT.
As part of a randomized clinical trial, MATCH treatments are costly to produce. However, when estimates are used to project these costs to nonresearch clinical settings, the costs are greatly reduced. Whereas MET appears to be much less costly to deliver in nonresearch settings than the other two treatments, the estimated cost differentials are less than the 1:3 treatment session ratio for MET versus TSF or CBT.
作为对一项随机酒精治疗匹配试验（项目MATCH）进行全面成本效益分析的第一步，本研究考察了三种由手册指导的、针对个体的治疗方法的相对成本，以及在非研究环境中复制这些治疗方法的成本。
在项目MATCH九个地点中的两个地点（威斯康星州密尔沃基市和罗德岛州普罗维登斯市）的三个治疗点，评估了在12周内提供12节认知行为疗法（CBT）、4节动机增强疗法（MET）和12节十二步促进疗法（TSF）的成本。研究成本计算包括确定总治疗成本、每接触小时平均成本和每位研究参与者平均成本时的临床、行政和培训/监督变量。来自所有九个MATCH地点的研究人员估计了复制这些治疗方法的直接临床成本、行政间接费用和培训/监督成本。
对于项目MATCH，MET每患者接触小时的成本（平均 = 498美元）是CBT（平均 = 198美元）和TSF（平均 = 253美元）的两倍或更多，但每位研究参与者的成本（平均 = 1700美元）低于CBT（平均 = 1901美元）和TSF（平均 = 1969美元）。对于临床复制，每位患者的高端成本从MET的512美元到TSF的750美元再到CBT的788美元不等：MET比TSF节省成本238美元（32%），比CBT节省成本276美元（35%）。
作为随机临床试验的一部分，MATCH治疗方法的生产成本很高。然而，当将这些成本估计应用于非研究临床环境时，成本会大幅降低。虽然MET在非研究环境中的实施成本似乎比其他两种治疗方法低得多，但估计的成本差异小于MET与TSF或CBT的1:3治疗节数比例。
