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The Effect of Alcohol Treatment on Social Costs of Alcohol Dependence: Results From the COMBINE Study

Zarkin, Gary A. PhD*; Bray, Jeremy W. PhD*; Aldridge, Arnie MS*; Mills, Michael MA*; Cisler, Ron A. PhD; Couper, David PhD; McKay, James R. PhD§; O'Malley, Stephanie PhD

doi: 10.1097/MLR.0b013e3181d68859
Original Article

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.

Objectives: 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.

Research Design: A cost study based on a randomized controlled clinical trial.

Subjects: 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.

From the *RTI International, Research Triangle Park, NC; †Center for Urban Population Health, University of Wisconsin–Milwaukee, University of Wisconsin School of Medicine and Public Health, and Aurora Health Care, Inc, Milwaukee, WI; ‡University of North Carolina, Chapel Hill, NC; §University of Pennsylvania, and Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; and ¶Yale University, New Haven, CT.

Supported by NIAAA grant 1-R01-AA12788 and K05014715.

Reprints: Gary A. Zarkin, PhD, RTI International, 3040 Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.