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).

• Authors: Philippe Laramée, Thor-Henrik Brodtkorb, Nora Rahhali, Chris Knight, Carolina Barbosa, Clément François, Mondher Toumi, Jean-Bernard Daeppen, Jürgen Rehm
• Journal: BMJ open (BMJ Open) Vol. 4 Issue 9 Pg. e005376 (Sep 16 2014) ISSN: 2044-6055 [Electronic] England
• PMID: 25227627 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Naltrexone
• nalmefene

Topics

• Alcohol Drinking (economics, prevention & control)
• Alcoholism (drug therapy)
• Combined Modality Therapy (economics)
• Cost-Benefit Analysis
• Female
• Humans
• Male
• Markov Chains
• Middle Aged
• Naltrexone (analogs & derivatives, economics, therapeutic use)
• Public Health
• Risk Assessment
• Social Support