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Cost effectiveness of Acamprosate in alcoholism treatment

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  1. Cost effectiveness of Acamprosate in alcoholism treatment Thin Thin OhnPhong VuFelipe Macias

  2. Introduction Alcoholism: • refer to all types of excessive alcohol consumption, regardless of whether the meet the diagnostic criteria for alcohol abuse and alcohol dependence

  3. Burden of Disease attributable to alcohol consmuption • US: Alcohol and drug users are among the highest cost users of health care (Zook ans Moore, 1980) • US: Alcoholics have been reported to consume up to 15 cents for every dollar spent on health care (Holder, 1987) • France: Costs owing to alcoholism correspond to 1% of GDP (Reynaud, 2001) • Finland: Direct health alone represnts 0.6% of GDP. (Hein, 1999)

  4. Global Burden of Disease

  5. Treatment options Acute detoxification Assisted rehabilitation - Psychosocial Support - Drugs (i.e. Naltrexone, Acamprosate)

  6. Acamprosate • Acomprosate is a prescription drug commonly used to treat alchol dependance in people who have stopped drinking. • acamprosate is associated with a significantly higher percentage of abstinent days than placebo (52.3% for placebo vs 72.5% for Acomprosate P = 0.02). No deaths or serious drug-related adverse events. ( Garbutt, 1999)

  7. Objectives • To assess the cost-utility ratio of Acamprosate treatment if compare to standard treatment. • Perspective of analysis: Germany health system

  8. Research Question • Is Acamprosate is more cost effective than the standard treatment in terms of cost-utility ratios on alcoholics from the health system perspective for long term?

  9. Methodology Study Design: Markov model simulating cohort for 40 years. Sample andsetting:1000 alcoholics from Germany Intervention: Acamprosate 2 tabs a day. Outcome measures: direct costs from fatty liver, cirrhosis, primary liver cell cancer, and death. Statistical analysis:Cost analysis, QALY analysis, and Cost-Utility analysis


  11. Markov Model to show the development of important alcohol related complications Alcoholics (No liver disease ) 0.167 0 0 Fatty liver 0 0.02 cirrhosis 0.129 0.0462 Death Primary Liver cell carcinoma 0.668 Annual probability of health state if alcoholics & Annual probability of health state if abstinent on Acamprosate

  12. Markov Model to show the development of important alcohol related complications (complete model)

  13. Transition probabilities for alcoholics

  14. Transition probabilities for abstinent after Acamprosate

  15. Costs and Effects of Alcoholics

  16. Costs of Acamprosate

  17. Discounting • Discounting future cost at 3%

  18. Cost-Utility

  19. Incremental Cost – Utility Ratio ∆Cost = 1275.24 DEM per QALY gained ∆QALY

  20. Decision • There is no universally accepted threshold for favourable ICER • But there is a general consensus that it falls in the range of $US20 000 to $US40 000 per QALY gained (mean of $US30 000, equivalent to approximately to 37,113 DEM) • Therefore, we considered any cost-effectiveness ratio less than 37,113 DEM in our analysis to be indicative of good value for money

  21. 1275.24 DEM per QALY gained <37,113 DEM per QALY gained

  22. Limitations • The Markov model for alcoholic complications are not comprehensive. • No sensitivity analysis was done for uncertainty. • Discounting was not done for QALY • Utility weights used in this model are not from Germany or from alcoholic liver disease. • Only direct cost (i.e. drug costs) is included, no indirect cost or intangible costs are not included. • We did not take relapse rate into account in the model.

  23. References • Garbutt JC, West SL, Carey TS. Pharmacological treatment of alcohol dependance: A review of the evidence. JAMA 1999;28: 1318-1325. • Paille FM, Guelf JD, Perkins AC, Royer RJ, Steru S and Parot P. 1995, “ Double-blind randomized multicentre trial of acamprosate in maintaining abstinence from alcohol”, Alcohol and Alcoholism,; 30(2): 239-247 • J Thompson Coon, G Rogers, P Hewson, D Wright, R Anderson, M Cramp, S Jackson, S Ryder, A Price and K Stein.2007, “Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis” Health Technology Assessment, 11 (34). • A.J. Palmer, K. Neeser, C. Weiss, A. Brandt, S.Comte and M. Fox, 2000” The long-term cost-effectiveness of improving alcohol abstinence with adjuvant acamprosate”, Alcohol and Alcoholism, 35(5)478-492. • Younsossi, Z, M., Singer, M. E., McHutchison, J. G. and Shermock, K. M, 199, “Cost effectiveness of Interferon α2b combined with Ribavirin for the treatment of chronic hepatitis C”, Hepatology, 30:1318-1324. • Johnell, O., Jonsson, B. Jonsson, L, 2003, “Cost effectiveness of Alendronate for the treatment of osteoporosis and prevention of Fracture” Pharmacoeconomics, 21(5):305-314