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Cost effectiveness of Acamprosate in alcoholism treatment Thin Thin OhnPhong VuFelipe Macias
Introduction Alcoholism: • refer to all types of excessive alcohol consumption, regardless of whether the meet the diagnostic criteria for alcohol abuse and alcohol dependence
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)
Treatment options Acute detoxification Assisted rehabilitation - Psychosocial Support - Drugs (i.e. Naltrexone, Acamprosate)
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)
Objectives • To assess the cost-utility ratio of Acamprosate treatment if compare to standard treatment. • Perspective of analysis: Germany health system
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?
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
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
Markov Model to show the development of important alcohol related complications (complete model)
Discounting • Discounting future cost at 3%
Incremental Cost – Utility Ratio ∆Cost = 1275.24 DEM per QALY gained ∆QALY
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
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.
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