Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis.
Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis.
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DOI：
10.1016/j.jhep.2020.12.004
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发表时间：
2021-06
影响因子：
25.7
通讯作者：
Mellinger JL
中科院分区：
文献类型：
--
作者：
Avanceña ALV;Miller N;Uttal SE;Hutton DW;Mellinger JL
酒精使用治疗，如药物辅助疗法和咨询，在促进戒酒方面是有效的。我们试图探讨代偿性酒精相关性肝硬化（AC）患者不同酒精使用治疗的成本-效果。我们模拟了一组在肝病诊所接受治疗的代偿AC患者。我们从医疗保健和社会角度估计了成本（以2017年美元为单位）和质量调整生命年（QALYs）的收益。转移概率、成本和健康效用权重均取自文献。美国食品和药物管理局（FDA）批准的mat（阿坎前列酸和纳曲酮）和非FDA批准的mat（巴氯芬、加巴喷丁和托吡酯）的治疗效果和咨询是基于对雇主保险的AC患者的研究。我们计算了增量成本-效果比（ICERs），并进行了单向和概率敏感性分析，以了解参数不确定性的影响。与什么都不做的情况相比，从医疗保健的角度来看，MATs和咨询可以节省成本，这意味着它们比不干预提供更多的好处，成本更低。与其他干预措施相比，阿坎普罗酯和纳曲酮成本最低，质量生活质量最高。如果MATs和咨询的有效性下降，这些干预措施仍然具有成本效益，基于通常使用的每个QALY获得10万美元的门槛。一些敏感性和情景分析表明，我们的主要发现是稳健的。在代偿的AC患者中，MATs和咨询是极具成本效益的，在某些情况下可以节省成本，是预防代偿失代偿和改善健康的干预措施。卫生政策（如付款人报销）应强调并适当补偿这些干预措施。酒精使用治疗，包括医生咨询和药物辅助疗法（MATs），改善了代偿性酒精相关性肝硬化（AC）患者的预后，尽管使用和获取仍然不是最佳的。在这项研究中，我们发现咨询和MATs具有极高的成本效益，在某些情况下可以节省成本，帮助代偿AC患者戒除酒精并改善他们的健康状况。应鼓励更广泛地使用这些干预措施。
Alcohol use treatment such medication-assisted therapies (MATs) and counseling are available and effective in promoting alcohol abstinence. We sought to explore the cost-effectiveness of different alcohol use treatments among patients with compensated alcohol-related cirrhosis (AC). We simulated a cohort of compensated AC patients receiving care from a hepatology clinic over their lifetimes. We estimated costs (in 2017 US$) and benefits in terms of quality-adjusted life years (QALYs) gained from healthcare and societal perspectives. Transition probabilities, costs, and health utility weights were taken from the literature. Treatment effects of Food and Drug Administration (FDA)-approved MATs (acamprosate and naltrexone) and non-FDA approved MATs (baclofen, gabapentin, and topiramate) and counseling were based on a study of employer-insured AC patients. We calculated incremental cost-effectiveness ratios (ICERs) and performed one-way and probabilistic sensitivity analyses to understand the impact of parameter uncertainty. When compared to a do-nothing scenario, MATs and counseling were found to be cost-saving from a healthcare perspective, which means that they provide more benefits with less costs than no intervention. Compared to other interventions, acamprosate and naltrexone cost the least and provide the most QALYs. If the effectiveness of MATs and counseling decreased, these interventions would still be cost-effective based on the commonly-used $100,000 per QALY gained threshold. Several sensitivity and scenario analyses showed that our main findings are robust. Among compensated AC patients, MATs and counseling are extremely cost-effective, and in some cases cost-saving, interventions to prevent decompensation and improve health. Health policies (e.g., payer reimbursement) should emphasize and appropriately compensate for these interventions. Alcohol use treatments, including physician counseling and medication-assisted therapies (MATs), improve the outcomes of patients with compensated alcohol-related cirrhosis (AC), though use and access have remained suboptimal. In this study, we found that counseling and MATs are extremely cost-effective, and in some cases cost-saving, interventions to help compensated AC patients abstain from alcohol and improve their health. Wider use of these interventions should be encouraged.
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评估肝移植的酒精性肝病患者的性别差异。
影响因子：
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McElroy LM;Likhitsup A;Scott Winder G;Saeed N;Hassan A;Sonnenday CJ;Fontana RJ;Mellinger J
通讯作者：
Mellinger J