title: The effect of alcohol treatment on social costs of alcohol dependence: results from the COMBINE study.
abstract: BACKGROUND
  The COMBINE (combined pharmacotherapies and behavioral intervention) clinical trial recently evaluated the efficacy of pharmacotherapies, behavioral therapies, and their combinations for the treatment of alcohol dependence. Previously, the cost and cost-effectiveness of COMBINE have been studied. Policy makers, patients, and nonalcohol-dependent individuals may be concerned not only with alcohol treatment costs but also with the effect of alcohol interventions on broader social costs and outcomes.
  
  
  OBJECTIVE
  To estimate the sum of treatment costs plus the costs of health care utilization, arrests, and motor vehicle accidents for the 9 treatments in COMBINE 3 years postrandomization.
  
  
  METHODS
  A cost study based on a randomized controlled clinical trial.
  
  
  METHODS
  : The study involved 786 participants 3 years postrandomization.
  
  
  RESULTS
  Multivariate results show no significant differences in mean costs between any of the treatment arms as compared with medical management (MM) + placebo for the 3-year postrandomization sample. The median costs of MM + acamprosate, MM + naltrexone, MM + acamprosate + naltrexone, and MM + acamprosate + combined behavioral intervention were significantly lower than the median cost for MM + placebo.
  
  
  CONCLUSIONS
  The results show that social cost savings are generated relative to MM + placebo by 3 years postrandomization, and the magnitude of these cost savings is greater than the costs of the COMBINE treatment received 3 years prior. Our study suggests that several alcohol treatments may indeed lead to reduced median social costs associated with health care, arrests, and motor vehicle accidents.
authors.affiliation: RTI International, Research Triangle Park, NC 27709, USA. gaz@rti.org
authors.forename: Gary A
authors.initials: GA
authors.lastname: Zarkin
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Bray
authors.forename: Arnie
authors.initials: A
authors.lastname: Aldridge
authors.forename: Michael
authors.initials: M
authors.lastname: Mills
authors.forename: Ron A
authors.initials: RA
authors.lastname: Cisler
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.forename: Stephanie
authors.initials: S
authors.lastname: O'Malley
mesh_terms: D000077443:Acamprosate; D000063:Accidents, Traffic / Q000191:economics* / Q000706:statistics & numerical data; D000427:Alcohol Deterrents / Q000191:economics / Q000627:therapeutic use; D019973:Alcohol-Related Disorders / Q000191:economics* / Q000628:therapy*; D001521:Behavior Therapy / Q000191:economics; D003365:Costs and Cost Analysis; D003415:Crime / Q000191:economics* / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D009271:Naltrexone / Q000191:economics / Q000627:therapeutic use; D013654:Taurine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate
references.citation: Addiction. 2000 Jul;95(7):999-1013
references.pmid: 10962766
references.citation: J Health Econ. 2001 Jul;20(4):461-94
references.pmid: 11469231
references.citation: J Subst Abuse Treat. 2003 Jul;25(1):51-7
references.pmid: 14512108
references.citation: Drug Alcohol Depend. 2004 Jun 11;74(3):223-34
references.pmid: 15194200
references.citation: JAMA. 2004 Mar 10;291(10):1238-45
references.pmid: 15010446
references.citation: J Stud Alcohol. 2001 Jan;62(1):89-97
references.pmid: 11271969
references.citation: J Subst Abuse. 1991;3(1):13-27
references.pmid: 1821272
references.citation: J Stud Alcohol Suppl. 2005 Jul;(15):50-5; discussion 33
references.pmid: 16223056
references.citation: JAMA. 2006 May 3;295(17):2003-17
references.pmid: 16670409
references.citation: Med Care. 2004 Apr;42(4):395-402
references.pmid: 15076817
references.citation: Prev Sci. 2006 Dec;7(4):333-42
references.pmid: 16845591
references.citation: Med Care. 2010 Apr;48(4):306-13
references.pmid: 20355261
references.citation: Arch Gen Psychiatry. 2008 Oct;65(10):1214-21
references.pmid: 18838638
references.citation: BMJ. 2005 Sep 10;331(7516):544
references.pmid: 16150765
references.citation: J Stud Alcohol. 1997 Nov;58(6):625-37
references.pmid: 9391923
references.citation: Alcohol Health Res World. 1987 Fall;12(1):8-15
references.pmid: 10312354
references.citation: J Stud Alcohol Drugs. 2007 Mar;68(2):248-55
references.pmid: 17286343
references.citation: J Stud Alcohol. 2004 Nov;65(6):758-65
references.pmid: 15700514
references.citation: J Subst Abuse Treat. 1996 Nov-Dec;13(6):453-66
references.pmid: 9219142