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. Issue 9 (16th September 2014)

• Record Type: Journal Article
• Authors: Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen
• Is Part Of: BMJ open. Volume 4:Issue 9(2014)
• Publication Date: 2014-09-16
• Subjects: Nalmefene -- Alcohol dependence -- Cost-effectiveness -- Cost-utility -- QALY -- Economic analysis; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2014-005376
• Languages: English
• ISSNs: 2044-6055

Abstract

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 ).