The long-term cost-effectiveness of improving alcohol abstinence with adjuvant acamprosate

A computer model was developed with decision analysis software to explore t he long-term clinical and economic outcomes of alcohol abstinence maintenan ce with either standard counselling therapy or standard therapy plus 48 wee ks of adjuvant acamprosate in detoxified alcoholic patients, important comp lications of alcoholism were modelled using Markov processes, and included relapse (return to drinking), alcohol-related hepatic disease, acute and ch ronic pancreatitis, acute and chronic gastritis, oropharyngeal carcinoma. o esophageal carcinoma. alcoholic cardiomyopathy, alcohol-related peripheral neuropathy, alcoholic psychosis, accidental death. and suicide. Probabiliti es of developing complications were dependent on whether the patients withi n the cohort remained abstinent or had relapsed. Relapse rates, probabiliti es, and costs for acamprosate therapy and treatment of complications were t aken from published literature. The analysis was performed from die German health insurance perspective. Life expectancy and total lifetime costs (cos ts of initial abstinence maintenance therapy plus costs of complications) w ere calculated for a typical male cohort with average age of 41 years, 80% with fatty liver, 15% with cirrhosis, 22% with chronic pancreatitis, and 18 with alcoholic cardiomyopathy at baseline. Life expectancy with and withou t acamprosate therapy was 15.90 and 14.70 years respectively, and discounte d (5% per annum) average total lifetime costs per patient were DEM 46 448 o mit DEM 49 549 respectively. We conclude that, despite the acquisition cost s of DEM 2177, adjuvant acamprosate therapy was both clinically and economi cally attractive under conservative assumptions.