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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

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Abstract

Aim

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.

Conclusion

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.

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References

  1. van Gils PF, Hamberg-van Reenen HH, van den Berg M, Tariq L, de Wit GA. The scope of costs in alcohol studies: cost-of-illness studies differ from economic evaluations. Cost Eff Resour Alloc. 2010;6(8):15. doi:10.1186/1478-7547-8-15.

    Article  Google Scholar 

  2. Anderson P, Baumberg B. Alcohol in Europe: a public health perspective. In: European Commission Archives. 2006. http://ec.europa.eu/health/archive/ph_determinants/life_style/alcohol/documents/alcohol_europe_en.pdf. Accessed 21 Jan 2014.

  3. Laramée P, Kusel J, Leonard S, Aubin H-J, François C, Daeppen J-B. The economic burden of alcohol dependence in Europe. Alcohol. 2013;48(3):259–69. doi:10.1093/alcalc/agt004.

    Article  Google Scholar 

  4. Department for Transport. Road causalities: Great Britain 2007. Annual report. In: National Archives. 2007. http://webarchive.nationalarchives.gov.uk/20110503151558/http:/www.dft.gov.uk/adobepdf/162469/221412/221549/227755/rcgb2007.pdf. Accessed 29 May 2014.

  5. Flatley J, Kershaw C, Smith K, Chaplin R, Moon D. Crime in England and Wales 2009/10. In: Great Britain Home Office. 2010. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/116347/hosb1210.pdf. Accessed 21 Jan 2014.

  6. Institute of Alcohol Studies. Alcohol and the working population. In: Institute of Alcohol Studies. 2009. http://www.ias.org.uk/Alcohol-knowledge-centre/Alcohol-in-the-workplace/Factsheets/Alcohol-and-the-working-population.aspx. Accessed 12 Mar 2015.

  7. Gual A, He Y, Torup L, van den Brink W, Mann K, ESENSE 2 Study Group. A randomised, double-blind, placebo-controlled, efficacy study of nalmefene, as-needed use, in patients with alcohol dependence. Eur Neuropsychopharmacol. 2013;23:1432–42.

    Article  CAS  PubMed  Google Scholar 

  8. Mann K, Bladstrom A, Torup L, Gual A, van den Brink W. Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene. Biol Psychiatry. 2013;73:706–13.

    Article  CAS  PubMed  Google Scholar 

  9. van den Brink W, Sorensen P, Torup L, Mann K, Gual A, The SENSE Study Group. Long-term efficacy, tolerability and safety of nalmefene as-needed in patients with alcohol dependence: a 1-year, randomised controlled study. J Psychopharmacol. 2014;28:733–44.

    Article  PubMed  Google Scholar 

  10. Laramée P, Brodtkorb T-H, Rahhali N, Knight C, Barbosa C, François C, Toumi M, Daeppen J-B. The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model. BMJ Open. 2014;4(9):e005376. doi:10.1136/bmjopen-2014-005376.

    Article  PubMed  PubMed Central  Google Scholar 

  11. National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. NICE technology appraisal guidance (TA325). In: National Institute for Health and Care Excellence. November 2014. https://www.nice.org.uk/guidance/ta325. Accessed 10 Mar 2015.

  12. National Institute for Health and Care Excellence. Single technology appraisal: nalmefene for reducing alcohol consumption in people with alcohol dependence. Final scope. In: National Institute for Health and Care Excellence. 2014. http://www.nice.org.uk/guidance/ta325/documents/alcohol-dependence-nalmefene-final-scope2. Accessed 10 Mar 2015.

  13. National Institute for Health and Care Excellence. Clinical guidelines CG115. Alcohol dependence and harmful alcohol use. In: National Institute for Health and Care Excellence. 2011. http://www.nice.org.uk/guidance/cg115/resources/guidance-alcoholuse-disorders-diagnosis-assessment-and-management-of-harmful-drinking-and-alcohol-dependence-pdf. Accessed 12 Mar 2015.

  14. van den Brink W, Aubin HJ, Bladström A, Torup L, Gual A, Mann K. Efficacy of as-needed nalmefene in alcohol-dependent patients with at least a high drinking risk level: results from a subgroup analysis of two randomized controlled 6-month studies. Alcohol Alcohol. 2013;48(5):570–8.

  15. Committee for Medicinal Products for Human Use. European public assessment report: nalmefene. In: European Medicines Agency. 2014. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/002583/WC500140303.pdf. Accessed 12 Mar 2015.

  16. Starosta AN, Leeman RF, Volpicelli JR. The BRENDA model: integrating psychosocial treatment and pharmacotherapy for the treatment of alcohol use disorders. J Psychiatr Pract. 2006;12:80.

    Article  PubMed  PubMed Central  Google Scholar 

  17. World Health Organization, Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health Cluster. International guide for monitoring alcohol consumption and related harm. In: World Health Organization. 2000. http://whqlibdoc.who.int/hq/2000/who_msd_msb_00.4.pdf. Accessed 12 Mar 2015.

  18. Brennan A, Meier P, Purshouse R, Rafia R, Meng Y, Hill-Macmanus D, Angus C, Holmes J. The Sheffield Alcohol Policy Model—a mathematical description. Health Econ. 2015;24(10):1368–88. doi:10.1002/hec.3105.

    Article  Google Scholar 

  19. Purshouse R, Brennan A, Latimer N, Meng Y, Rafia R, Jackson R, Meier P. Modelling to assess the effectiveness and cost-effectiveness of public health related strategies and interventions to reduce alcohol attributable harm in England using the Sheffield Alcohol Policy Model version 2.0: report to the NICE Public Health Program. In: National Institute for Health and Care Excellence. 2009. http://guidance.nice.org.uk/PHG/21/EconomicModellingReport/pdf/English. Accessed 10 Mar 2015.

  20. Rehm J, Shield KD, Rehm MX, Gmel G, Frick U. Alcohol consumption, alcohol dependence and attributable burden of disease in Europe. In: Centre for Addiction and Mental Health. 2012. http://amphoraproject.net/w2box/data/AMPHORA%20Reports/CAMH_Alcohol_Report_Europe_2012.pdf. Accessed 10 Mar 2015.

  21. Home Office. Research, Development and Statistics Directorate. Offending Surveys and Research, National Centre for Social Research and BMRB. Social research, offending, crime and justice survey, 2005. 3rd edition [database]. Colchester: UK Data Archive. December 2008.

  22. Department of Health. Safe, sensible, social—consultation on further action. In: National Archives. 2008. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_086412. Accessed 29 May 2014.

  23. Home Office. The economic and social costs of crime against individuals and households 2003/04. Online report 30/05. In: National Archives. 2005. http://webarchive.nationalarchives.gov.uk/20100413151441/http:/www.homeoffice.gov.uk/rds/pdfs05/rdsolr3005.pdf. Accessed 5 Jun 2014.

  24. Brand S, Price R. Home office research study 217. The economic and social costs of crime. In: National Archives. 2000. http://webarchive.nationalarchives.gov.uk/20110218135832/rds.homeoffice.gov.uk/rds/pdfs/hors217.pdf. Accessed 17 Mar 2015.

  25. Dubourg R, Hamed J, Thorns J. The economic and social costs of crime against individuals and households 2003/04. Home office online report 30/05. In: National Archives. 2005. http://webarchive.nationalarchives.gov.uk/20100413151441/http:/www.homeoffice.gov.uk/rds/pdfs05/rdsolr3005.pdf. Accessed 17 Mar 2015.

  26. Office for National Statistics. Consumer price inflation, December 2013. In: Office for National Statistics. 2014. http://www.ons.gov.uk/ons/rel/cpi/consumer-price-indices/december-2013/index.html. Accessed 18 Feb 2015.

  27. MacDonald Z, Shields MA. Does problem drinking affect employment? Evidence from England. Health Econ. 2004;13(2):139–55.

    Article  PubMed  Google Scholar 

  28. Jarl J, Gerdtham U-G. Does drinking affect long-term sickness absence? A sample selection approach correcting for employment and accounting for drinking history. Appl Econ. 2012;44(22):2811–25.

    Article  Google Scholar 

  29. Roche AM, Pidd K, Berry JG, Harrison JE. Workers’ drinking patterns: the impact on absenteeism in the Australian work-place. Addiction. 2008;103(5):738–48.

    Article  PubMed  Google Scholar 

  30. French MT, Maclean JC, Sindelar JL, Fang H. The morning after: alcohol misuse and employment problems. Appl Econ. 2011;43(21):2705–20.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cabinet Office Strategy Unit. Alcohol misuse: how much does it cost? In: Società Italiana di Alcologia. 2003. http://sia.dfc.unifi.it/costi%20uk.pdf. Accessed 17 Mar 2015.

  32. Office for National Statistics. Labour market statistics 2014. In: Office for National Statistics. 2014. http://www.ons.gov.uk/ons/rel/lms/labour-market-statistics/january-2014/index.html. Accessed 18 Feb 2015.

  33. Office for National Statistics. Full report: sickness absence in the labour market, February 2014. In: Office for National Statistics. 2014. http://www.ons.gov.uk/ons/dcp171776_353899.pdf. Accessed 18 Feb 2015.

  34. Office for National Statistics. Annual survey of hours and earnings, 2012 revised results. In: Office for National Statistics. 2013. http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-328218. Accessed 18 Feb 2015.

  35. Wonderling D, Sawyer L, Fenu E, Lovibond K, Laramée P. National Clinical Guideline Centre cost-effectiveness assessment for the National Institute for Health and Clinical Excellence. Ann Intern Med. 2011;154(11):758–65.

    Article  PubMed  Google Scholar 

  36. National Health Service. Reference cost database. Elective inpatient HRG data; currency code DZ11A, DZ11B, DZ11C, DZ23A, DZ23B, DZ23C. In: Gov.UK, 2010–2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215298/dh_131145.xls. Accessed 12 Mar 2015.

  37. Personal Social Services Research Unit. Unit costs of health and social care. In: Personal Social Services Research Unit. 2012. http://www.pssru.ac.uk/project-pages/unit-costs/2012/index.php?file=full. Accessed 12 Mar 2015.

  38. National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013. In: National Institute for Health and Care Excellence. April 2013. http://www.nice.org.uk/media/D45/1E/GuideToMethodsTechnologyAppraisal2013.pdf. Accessed 5 Jun 2014.

  39. Briggs AH, Weinstein MC, Fenwick EA, Karnon J, Sculpher MJ, Paltiel AD; ISPOR-SMDM Modeling Good Research Practices Task Force. Model parameter estimation and uncertainty: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-6. Value Health. 2012;15(6):835–42.

  40. Eddy DM, Hollingworth W, Caro JJ, Tsevat J, McDonald KM, Wong JB. Model transparency and validation a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-7. Med Decis Making. 2012;32(5):733–43.

    Article  PubMed  Google Scholar 

  41. National Institute for Health and Care Excellence. Specification for manufacturer/sponsor submission for Single Technology Appraisal (STA). In: National Institute for Health and Care Excellence. 2013. https://www.nice.org.uk/proxy/?sourceUrl=http%3a%2f%2fwww.nice.org.uk%2fmedia%2fD54%2f6E%2fSpecificationForManufacturerSponsorSubmissionOfEvidenceJune2012.doc. Accessed 12 Mar 2015.

  42. National Institute for Health and Care Excellence. NICE technology appraisal guidance [TA325]—nalmefene for reducing alcohol consumption in people with alcohol dependence. In: National Institute for Health and Care Excellence. 2014. https://www.nice.org.uk/guidance/ta325. Accessed 25 Nov 2014.

  43. National Institute for Health and Care Excellence. Final appraisal determination—nalmefene for reducing alcohol consumption in people with alcohol dependence. In: National Institute for Health and Care Excellence. 2014. https://www.nice.org.uk/guidance/gid-tag442/documents/alcohol-dependence-nalmefene-id660-final-appraisal-determination-document-2. Accessed 25 Nov 2014.

  44. Brennan A, Meier P, Purshouse R, Rafia R, Meng Y, Hill-Macmanus D. Developing policy analytics for public health strategy and decisions—the Sheffield Alcohol Policy Model framework. Ann Oper Res. 2016;236(1):149–76. doi:10.1007/s10479-013-1451-z.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Marshall EJ. Adolescent alcohol use: risks and consequences. Alcohol Alcohol. 2014;49(2):160–4. doi:10.1093/alcalc/agt180.

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Author information

Authors and Affiliations

  1. RTI Health Solutions, Vällebergsv 9B, 45930, Ljungskile, Sweden

    Thor-Henrik Brodtkorb

  2. RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 6AR, UK

    Melissa Bell

  3. NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia

    Adam H. Irving

  4. Social and Epidemiological Research Program, Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada

    Philippe Laramée

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  1. Thor-Henrik Brodtkorb
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  4. Philippe Laramée
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Corresponding author

Correspondence to Thor-Henrik Brodtkorb.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflicts of interest

Philippe Laramée was an employee of Lundbeck SAS when this study was conducted. Thor-Henrik Brodtkorb, Melissa Bell and Adam H. Irving are or were employees of RTI Health Solutions and were contracted by Lundbeck SAS to support the study. The authors had full control of all primary data and agreed to allow the journal to review the data, if such a review was requested.

Funding

This study was funded by Lundbeck SAS. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript, apart from those disclosed.

Additional information

Philippe Laramée was formerly at Lundbeck SAS, 92445 Issy-les-Moulineaux Cedex, France

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Brodtkorb, TH., Bell, M., Irving, A.H. et al. 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. CNS Drugs 30, 163–177 (2016). https://doi.org/10.1007/s40263-016-0310-2

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