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The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

Published version
Peer-reviewed

Repository DOI


Type

Article

Change log

Authors

Stanley, George 
Mirza, Zulfiquar 

Abstract

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 5-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 5-day course of IV thiamine, vs a 2- and 10-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 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) 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 realise both the health benefits to patients and savings to the public purse.

Description

Keywords

Adult, Alcoholism, Emergency Service, Hospital, Humans, Male, Prospective Studies, Social Work, State Medicine, Thiamine, Thiamine Deficiency, Time Factors, United Kingdom, Wernicke Encephalopathy

Journal Title

Appl Health Econ Health Policy

Conference Name

Journal ISSN

1175-5652
1179-1896

Volume Title

14

Publisher

Springer Science and Business Media LLC
Sponsorship
This study was funded by Archimedes UK Pharma Ltd, the manufacturer of Pabrinex®. Hayward Medical Communications provided editorial and writing support during manuscript development.