title: 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: OBJECTIVE
  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.
  
  
  METHODS
  Decision modelling using Markov chains compared costs and effects over 5 years.
  
  
  METHODS
  The analysis was from the perspective of the National Health Service (NHS) in England and Wales.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).
authors.affiliation: Université Claude Bernard Lyon I, Villeurbanne, France Lundbeck S.A.S., Issy-les-Moulineaux Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
authors.affiliation: RTI Health Solutions, Ljungskile, Sweden.
authors.forename: Thor-Henrik
authors.initials: TH
authors.lastname: Brodtkorb
authors.affiliation: Lundbeck S.A.S., Issy-les-Moulineaux Cedex, France.
authors.forename: Nora
authors.initials: N
authors.lastname: Rahhali
authors.affiliation: BresMed Health Solutions, Sheffield, South Yorkshire, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Knight
authors.affiliation: Behavioral Health Economics Program, RTI International, Chicago,Illinois, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Barbosa
authors.affiliation: Lundbeck S.A.S., Issy-les-Moulineaux Cedex, France.
authors.forename: Clément
authors.initials: C
authors.lastname: François
authors.affiliation: Université Claude Bernard Lyon I, Villeurbanne, France.
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
authors.affiliation: Alcohol Treatment Centre, Lausanne University Hospital/CHUV, Lausanne, Switzerland.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Daeppen
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Canada Klinische Psychologie und Psychotherapie, TU Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000428:Alcohol Drinking / Q000191:economics* / Q000517:prevention & control*; D000437:Alcoholism / Q000188:drug therapy*; D003131:Combined Modality Therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011634:Public Health; D018570:Risk Assessment; D012944:Social Support
chemical_list: D009271:Naltrexone; C038981:nalmefene
keywords: Alcohol dependence; Cost-effectiveness; Cost-utility; Economic analysis; Nalmefene; QALY