Adjuvant drug treatment of alcoholism with acamprosate: between sectoral budgets and disease management

Objective: On the basis of several controlled clinical investigations the c ost-effectiveness of acamprosate as adjuvant therapy of alcohol-dependent p atients has yet been evaluated. These optimal conditions cannot be found in the daily ambulant practice and results in asking which of the alternative s >> standard plus acamprosate << or >> tandard without acamprosate <<. is more cost-effective in maintaining abstinence in alcohol dependent patients under realistic conditions. Patients and methods: In an open multi-centre study, medical care, costs an d therapeutic outcome was prospectively documented. Prior to enrolling, all patients were obliged to undergo a detoxification procedure. At a mean age of 45 years the patients suffered an average of ten years from alcohol dep endence. 521 patients were documented in the acamprosate cohort and 265 pat ients in the cohort >> other therapy << over one year. Two thirds of the pa rticipating patients were male. Results: At 33.6% the rate of abstinence was remarkably higher in the acamp rosate cohort in comparison to the cohort >> other << at 21.1 % abstinent p atients. The mean total costs per patient and year amounted to DM 3191 in t he acamprosate-cohort and were significantly lower than in the cohort >> ot her << with DM 4046. Effectiveness-adjusted costs of DM 9500 per successful ly treated patient in the acamprosate-cohort were superior to the cohort >> other <<, amounting to DM 19148 per successfully treated patient. Conclusion: The described economic benefits may be utilised under condition s of an adequate disease management.