Dataset Information

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

ABSTRACT:

Objectives

To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths.

Design

Decision modelling using Markov chains compared costs and effects over 5 years.

Setting

The analysis was from the perspective of the National Health Service (NHS) in England and Wales.

Participants

The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment.

Data sources

We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources.

Main outcome measures

We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided.

Results

Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years.

Conclusions

Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits.

Trial registration numbers

This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).

SUBMITTER: Laramee P

PROVIDER: S-EPMC4166142 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Publications

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

Laramée Philippe P Brodtkorb Thor-Henrik TH Rahhali Nora N Knight Chris C Barbosa Carolina C François Clément C Toumi Mondher M Daeppen Jean-Bernard JB Rehm Jürgen J

BMJ open 20140916 9

<h4>Objectives</h4>To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths.<h4>Design</h4>Decision modelling using Markov chains compared costs and effects over 5 years.<h4>Setting</h4 ...[more]

PMID: 25227627

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Dataset Information

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

Objectives

Design

Setting

Participants

Data sources

Main outcome measures

Results

Conclusions

Trial registration numbers

Publications

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

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