title: Modelling the consequences of a reduction in alcohol consumption among patients with alcohol dependence based on real-life observational data.
abstract: BACKGROUND
  Most available pharmacotherapies for alcohol-dependent patients target abstinence; however, reduced alcohol consumption may be a more realistic goal. Using randomized clinical trial (RCT) data, a previous microsimulation model evaluated the clinical relevance of reduced consumption in terms of avoided alcohol-attributable events. Using real-life observational data, the current analysis aimed to adapt the model and confirm previous findings about the clinical relevance of reduced alcohol consumption.
  
  
  METHODS
  Based on the prospective observational CONTROL study, evaluating daily alcohol consumption among alcohol-dependent patients, the model predicted the probability of drinking any alcohol during a given day. Predicted daily alcohol consumption was simulated in a hypothetical sample of 200,000 patients observed over a year. Individual total alcohol consumption (TAC) and number of heavy drinking days (HDD) were derived. Using published risk equations, probabilities of alcohol-attributable adverse health events (e.g., hospitalizations or death) corresponding to simulated consumptions were computed, and aggregated for categories of patients defined by HDDs and TAC (expressed per 100,000 patient-years). Sensitivity analyses tested model robustness.
  
  
  RESULTS
  Shifting from >220 HDDs per year to 120-140 HDDs and shifting from 36,000-39,000 g TAC per year (120-130 g/day) to 15,000-18,000 g TAC per year (50-60 g/day) impacted substantially on the incidence of events (14,588 and 6148 events avoided per 100,000 patient-years, respectively). Results were robust to sensitivity analyses.
  
  
  CONCLUSIONS
  This study corroborates the previous microsimulation modeling approach and, using real-life data, confirms RCT-based findings that reduced alcohol consumption is a relevant objective for consideration in alcohol dependence management to improve public health.
authors.affiliation: Lundbeck SAS, 37-45 Quai du Président Roosevelt, 92445, Issy-les-Moulineaux, Cedex, France. rano@lundbeck.com.
authors.forename: Nora
authors.initials: N
authors.lastname: Rahhali
authors.affiliation: Creativ-Ceutical, Paris, France. ami@creativ-ceutical.com.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Millier
authors.affiliation: Creativ-Ceutical, Paris, France. bbr@creativ-ceutical.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Briquet
authors.affiliation: Lundbeck SAS, 37-45 Quai du Président Roosevelt, 92445, Issy-les-Moulineaux, Cedex, France. laph@lundbeck.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
authors.affiliation: Creativ-Ceutical, Paris, France. sab@creativ-ceutical.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballéa
authors.affiliation: Aix-Marseille University, Marseille, France. Mondher.Toumi@emaud.org.
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
authors.affiliation: Lundbeck SAS, 37-45 Quai du Président Roosevelt, 92445, Issy-les-Moulineaux, Cedex, France. cfr@lundbeck.com.
authors.forename: Clément
authors.initials: C
authors.lastname: François
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada. jtrehm@gmail.com.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. jtrehm@gmail.com.|Klinische Psychologie und Psychotherapie, TU Dresden, Dresden, Germany. jtrehm@gmail.com.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Lausanne University Hospital, Lausanne, Switzerland. Jean-Bernard.Daeppen@chuv.ch.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Daeppen
mesh_terms: D000328:Adult; D064829:Alcohol Abstinence / Q000706:statistics & numerical data; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology*; D003198:Computer Simulation; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011446:Prospective Studies; D011634:Public Health