title: Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome.
abstract: OBJECTIVE
  Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS.
  
  
  METHODS
  This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective.
  
  
  RESULTS
  The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03).
  
  
  CONCLUSIONS
  Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.
authors.affiliation: Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: Vikram K
authors.initials: VK
authors.lastname: Reddy
authors.affiliation: Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: K
authors.initials: K
authors.lastname: Girish
authors.affiliation: Department of Psychiatry, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: Pandit
authors.initials: P
authors.lastname: Lakshmi
authors.affiliation: Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Vijendra
authors.affiliation: Department of Psychiatry, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pharmacology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Harsha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002707:Chlordiazepoxide / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000431:Ethanol; D002707:Chlordiazepoxide; D001418:Baclofen
keywords: Alcohol-withdrawal syndrome; baclofen; chlordiazepoxide; clinical institute withdrawal assessment for alcohol; cost-effectiveness analysis
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