title: A Comparison of Markov and Discrete-Time Microsimulation Approaches: Simulating the Avoidance of Alcohol-Attributable Harmful Events from Reduction of Alcohol Consumption Through Treatment of Alcohol Dependence.
abstract: OBJECTIVE
  When modelling the pathophysiology of a disease, it is important to select a modelling approach that can adequately replicate its course. The objective of this paper was to compare the outcomes obtained by the Markov and discrete-time microsimulation modelling approaches using nalmefene clinical trial data.
  
  
  METHODS
  Markov and microsimulation modelling approaches assessing alcohol dependence treatment with psychosocial support with or without nalmefene were compared in terms of the modelled evolution of patients' alcohol consumption and the resulting occurrence of alcohol-attributable harmful events over 1 year.
  
  
  RESULTS
  Comparison of the proportion of the modelled population at different levels of alcohol consumption over time revealed systematic differences arising from the different modelling techniques: a lower number of patients reaching abstinence, a higher number of patients at higher drinking levels, and, overall, a smoother evolution of alcohol consumption in the microsimulation. Reasons are discussed in the paper. While the models produced similar occurrences of alcohol-attributable harmful events as a whole, distinct results for the individual events were observed, explained by the specific pathophysiology of occurrence of these events and how their implementation was adapted to fit the limitations of the compared modelling approaches; however, these differences were only statistically significant for one of the eight events.
  
  
  CONCLUSIONS
  For a general public health or health economic assessment of alcohol use disorders, it is possible to achieve similar results with the compared approaches. To assess a patients' disease course, taking into consideration alcohol-attributable harmful events, the microsimulation approach may provide more precise results. However, further external validation of the models is needed and this additional precision may be outweighed by the greater computational burden of a microsimulation approach.
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada. plaramee@outlook.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Laramée
authors.affiliation: Health Economics and Outcomes Research, Creativ-Ceutical, 75008, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Millier
authors.affiliation: Health Economics, RTI Health Solutions, 45930, Ljungskile, Sweden.
authors.forename: Thor-Henrik
authors.initials: TH
authors.lastname: Brodtkorb
authors.affiliation: Global Analytics, Lundbeck SAS, 92445, Issy-les-Moulineaux CEDEX, France.
authors.forename: Nora
authors.initials: N
authors.lastname: Rahhali
authors.affiliation: Health Economics and Outcomes Research, Creativ-Ceutical, 75008, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cristeau
authors.affiliation: Health Economics and Outcomes Research, Creativ-Ceutical, 75008, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballéa
authors.affiliation: Costello Medical Consulting Ltd, Cambridge, CB2 1RE, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Montgomery
authors.affiliation: Costello Medical Consulting Ltd, Cambridge, CB2 1RE, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Steeves
authors.affiliation: Laboratoire de Santé Publique, Faculté de Médecine, Université de la Méditerranée, 13385, Marseille, France.
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.|Klinische Psychologie und Psychotherapie, TU Dresden, 01187, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy*; D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D000437:Alcoholism / Q000188:drug therapy*; D005260:Female; D006801:Humans; D009271:Naltrexone / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D009271:Naltrexone; C038981:nalmefene