OBJECTIVES

: Alcoholic cirrhosis (AC) patients who abstain from alcohol can prevent complications like liver decompensation and cancer that require transplantation. Medication-assisted therapies (MATs) using naltrexone, disulfiram, and acamprosate and psychosocial interventions such as cognitive behavioral therapy and motivational are effective in promoting abstinence and can be easily provided in a clinical setting. In this study, we explore the cost-effectiveness of these different alcohol cessation interventions compared to a do-nothing approach among AC patients.

METHODS

: We used a Markov model to simulate a cohort of 54-year-old AC patients receiving care from a hepatology clinic. We estimated costs and benefits (in terms of quality-adjusted life years [QALYs]) from healthcare and societal perspectives. Transition probabilities, costs (in 2017 US$), and health utility weights were taken from published and grey literature. The treatment effects of a 16-week course of MAT, counseling, and combined MAT and counseling were based on unpublished data from a large academic hospital. We calculated incremental cost-effectiveness ratios (ICERs) and performed one-way and probabilistic sensitivity analyses (PSA) using 10,000 Monte Carlo simulations to understand the impact of parameter uncertainty.

RESULTS

: In the base case analysis, counseling alone was associated with the lowest ICER (US$22,018 per QALY gained) followed by MAT alone (US$25,663 per QALY gained) when compared to a do-nothing scenario from a healthcare perspective. The combined counseling and MAT intervention was extendedly-dominated in the base case under both perspectives. One-way sensitivity analyses reveal that no extreme values of any parameter drive the ICER of MAT alone or counseling alone beyond the commonly-used US$50,000 per QALY threshold. The average ICERs from the PSA for MAT alone, counseling alone, and combined counseling and MAT are US$11,281, US$21,876, and US$20,848 per QALY gained, respectively, from a healthcare perspective.

CONCLUSIONS

: MATs and counseling are extremely cost-effective interventions to help AC patients abstain from alcohol and improve their health.