Cost methodology of COMBINE.
OBJECTIVE
This article describes the methodology used in estimating the mean cost per patient of the interventions delivered in COMBINE, a randomized controlled trial (RCT) comparing pharmacotherapies and behavioral interventions for outpatient treatment of alcohol dependence.


METHODS
Our methodology identifies a broad list of nonresearch activities necessary to implement the COMBINE interventions in standard clinical practice. For each activity, we include the time costs of clinical assessments and interventions by staff, the cost of space, laboratory charges and the cost of medical supplies. We also estimate the patients' time used for each of these activities.


RESULTS
We present the estimated cost per activity for 15 intake assessments plus the Medical Management (MM) and Combined Behavioral Intervention (CBI) sessions for 9 of the 11 COMBINE sites. Labor costs represent the bulk of the total cost for all activities. The Form 90 AIR/ED is the most expensive intake activity both in terms of labor and space costs. The CBI session is more expensive than the MM session.


CONCLUSIONS
Our methodology estimates the cost to treatment providers and to patients of implementing the COMBINE intervention in standard practice. Compared with previous methods, the prospective design of our methodology allows for higher quality data, and the detailed activity costing helps identify key cost drivers. Future analyses will present actual COMBINE intervention cost estimates based on trial data. Although this cost study is specific to the COMBINE interventions, the concepts, instruments and methods used here can be applied to any RCT.
Zarkin
Gary A
GA
RTI International, 3040 Cornwallis Road, Research Triangle Park, North Carolina 27709, USA. gaz@rti.org
Bray
Jeremy W
JW
Mitra
Debanjali
D
Cisler
Ron A
RA
Kivlahan
Daniel R
DR
D000437:Alcoholism / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000191:economics; D003365:Costs and Cost Analysis; D004358:Drug Therapy / Q000191:economics* / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D011613:Psychotherapy / Q000191:economics* / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000191:economics*