title: The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.
abstract: BACKGROUND
  Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded.
  
  
  OBJECTIVE
  To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs.
  
  
  METHODS
  A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %.
  
  
  RESULTS
  Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years.
  
  
  CONCLUSIONS
  Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.
authors.affiliation: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, CB2 0SR, UK. ed.wilson@medschl.cam.ac.uk.
authors.forename: Edward C F
authors.identifier: http://orcid.org/0000-0002-8369-1577
authors.initials: EC
authors.lastname: Wilson
authors.affiliation: Archimedes Pharma UK Ltd, South Oak Way, Green Park, Reading, RG2 6UG, UK.
authors.forename: George
authors.initials: G
authors.lastname: Stanley
authors.affiliation: West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex, TW7 6AF, UK.
authors.forename: Zulfiquar
authors.initials: Z
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012947:Social Work / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D013831:Thiamine / Q000627:therapeutic use*; D013832:Thiamine Deficiency / Q000188:drug therapy*; D013997:Time Factors; D006113:United Kingdom; D014899:Wernicke Encephalopathy / Q000188:drug therapy* / Q000209:etiology
chemical_list: D013831:Thiamine