title: The Cost-Effectiveness of the Integration of Nalmefene within the UK Healthcare System Treatment Pathway for Alcohol Dependence.
abstract: OBJECTIVE
  To assess the cost-effectiveness of integrating nalmefene within the treatment pathway for alcohol dependence recommended by the National Institute for Health and Care Excellence in the UK.
  
  
  METHODS
  A Markov model, taking a UK NHS perspective, followed a cohort with alcohol dependence and high/very high drinking risk levels (HVHDRLs), who do not require immediate detoxification and who continue at HVHDRLs after initial assessment, for 5 years. Costs and quality-adjusted life years (QALYs) from treatment with nalmefene plus psychosocial support versus psychosocial support alone were modelled. The consequent incidence of alcohol-attributable harmful events and disease progression, with the possibility of requiring other options or recurrent treatment, were captured.
  
  
  RESULTS
  Nalmefene plus psychosocial support dominated psychosocial support alone, with lower costs and increased QALYs after 5 years. Savings are driven by the higher response to nalmefene, and the subsequent lower cost accumulation for alternatives.
  
  
  CONCLUSIONS
  Nalmefene represents a highly cost-effective treatment option in this population. The analysis shows that integrating nalmefene within the current UK clinical treatment pathway for alcohol dependence could reduce the economic burden on the NHS by limiting harmful events and disease progression.
authors.affiliation: Social and Epidemiological Research Program, Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada plaramee@outlook.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
authors.affiliation: RTI Health Solutions, Manchester, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bell
authors.affiliation: NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Irving
authors.affiliation: RTI Health Solutions, Ljungskile, Sweden.
authors.forename: Thor-Henrik
authors.initials: TH
authors.lastname: Brodtkorb
mesh_terms: D000437:Alcoholism / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011613:Psychotherapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D009271:Naltrexone; C038981:nalmefene