The long-term cost to the UK NHS and social services of different durations of IV treatment (vitamin B1) for chronic alcohol misusers with symptoms of Wernicke's encephalopathy presenting at the emergency department
Applied Health Economics and Health Policy
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Wilson, E., Stanley, G., & Mirza, Z. (2015). The long-term cost to the UK NHS and social services of different durations of IV treatment (vitamin B1) for chronic alcohol misusers with symptoms of Wernicke's encephalopathy presenting at the emergency department. Applied Health Economics and Health Policy, 14 205-215. https://doi.org/10.1007/s40258-015-0214-1
Background: Wernicke’s encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum five-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. Objective: To estimate the cost impact on the UK public sector (NHS and social services) of a five-day course of IV thiamine, versus a two- and ten-day course, in harmful or dependent drinkers presenting to EDs. Methods: A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5%. Results: Increasing treatment from two to five days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by £87,000 per patient (95% confidence interval £19,300 to £172,300) over 35 years. Conclusions: Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realize both the health benefits to patients and savings to the public purse.
This study was funded by Archimedes UK Pharma Ltd, the manufacturer of Pabrinex®. Hayward Medical Communications provided editorial and writing support during manuscript development.
External DOI: https://doi.org/10.1007/s40258-015-0214-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/252326
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