title: The Cost Effectiveness of Nalmefene for Reduction of Alcohol Consumption in Alcohol-Dependent Patients with High or Very High Drinking-Risk Levels from a UK Societal Perspective.
abstract: OBJECTIVE
  To evaluate costs and health outcomes of nalmefene plus psychosocial support, compared with psychosocial intervention alone, for reducing alcohol consumption in alcohol-dependent patients, specifically focusing on societal costs related to productivity losses and crime.
  
  
  METHODS
  A Markov model was constructed to model costs and health outcomes of the treatments over 5 years. Analyses were conducted for nalmefene's licensed population: adults with both alcohol dependence and high or very high drinking-risk levels (DRLs) who do not require immediate detoxification and who have high or very high DRLs after initial assessment. The main outcome measure was cost per quality-adjusted life-year (QALY) gained as assessed from a UK societal perspective. Alcohol-attributable productivity loss, crime and health events occurring at different levels of alcohol consumption were taken from published risk-relation studies. Health-related and societal costs were drawn from public data and the literature. Data on the treatment effect, as well as baseline characteristics of the modelled population and utilities, came from three pivotal phase 3 trials of nalmefene.
  
  
  RESULTS
  Nalmefene plus psychosocial support was dominant compared with psychosocial intervention alone, resulting in QALYs gained and reduced societal costs. Sensitivity analyses showed that this conclusion was robust. Nalmefene plus psychosocial support led to per-patient reduced costs of £3324 and £2483, due to reduced productivity losses and crime events, respectively.
  
  
  CONCLUSIONS
  Nalmefene is cost effective from a UK societal perspective, resulting in greater QALY gains and lower costs compared with psychosocial support alone. Nalmefene demonstrates considerable public benefits by reducing alcohol-attributable productivity losses and crime events in adults with both alcohol dependence and high or very high DRLs who do not require immediate detoxification and who have high or very high DRLs after initial assessment.
authors.affiliation: RTI Health Solutions, Vällebergsv 9B, 45930, Ljungskile, Sweden. tbrodtkorb@rti.org.
authors.forename: Thor-Henrik
authors.initials: TH
authors.lastname: Brodtkorb
authors.affiliation: RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 6AR, 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 H
authors.initials: AH
authors.lastname: Irving
authors.affiliation: Social and Epidemiological Research Program, Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
mesh_terms: D000293:Adolescent; D000328:Adult; D000427:Alcohol Deterrents / Q000191:economics* / Q000627:therapeutic use; D000428:Alcohol Drinking / Q000188:drug therapy / Q000191:economics; D000437:Alcoholism / Q000191:economics* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000191:economics / Q000379:methods; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003415:Crime / Q000191:economics / Q000706:statistics & numerical data; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy / Q000191:economics* / Q000379:methods; D012306:Risk; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000427:Alcohol Deterrents; D009271:Naltrexone; C038981:nalmefene