Brodtkorb Thor-Henrik, Bell Melissa, Irving Adam H, Laramée Philippe
RTI Health Solutions, Vällebergsv 9B, 45930, Ljungskile, Sweden.
RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 6AR, UK.
CNS Drugs. 2016 Feb;30(2):163-77. doi: 10.1007/s40263-016-0310-2.
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.
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.
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.
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.
评估与单纯心理社会干预相比，纳曲酮加心理社会支持在减少酒精依赖患者饮酒量方面的成本和健康结局，特别关注与生产力损失和犯罪相关的社会成本。
构建马尔可夫模型以模拟5年治疗期内的成本和健康结局。对纳曲酮的许可人群进行分析：患有酒精依赖且饮酒风险水平高或极高、不需要立即戒酒且在初始评估后饮酒风险水平高或极高的成年人。主要结局指标是从英国社会角度评估的每获得一个质量调整生命年（QALY）的成本。不同饮酒水平下酒精所致生产力损失、犯罪和健康事件的数据来自已发表的风险关系研究。健康相关成本和社会成本来自公开数据和文献。治疗效果数据以及模拟人群的基线特征和效用数据来自纳曲酮的三项关键3期试验。
与单纯心理社会干预相比，纳曲酮加心理社会支持具有优势，可带来QALY增加并降低社会成本。敏感性分析表明该结论具有稳健性。纳曲酮加心理社会支持分别因生产力损失和犯罪事件减少，导致每位患者成本降低3324英镑和2483英镑。
从英国社会角度来看，纳曲酮具有成本效益，与单纯心理社会支持相比，可带来更多的QALY增加和更低的成本。对于患有酒精依赖且饮酒风险水平高或极高、不需要立即戒酒且在初始评估后饮酒风险水平高或极高的成年人，纳曲酮通过减少酒精所致生产力损失和犯罪事件，显示出可观的公共效益。
