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

Abstract

BackgroundWernicke’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.ObjectiveTo 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.MethodsA 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 %.ResultsIncreasing 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.ConclusionsIncreasing 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-015-0214-1) contains supplementary material, which is available to authorized users.

Experiences of Structured Elicitation for Model-Based Cost-Effectiveness Analyses

“…All applications recruited health care professionals (but not exclusively [20] , [21] ) on the basis of the following criteria: recognition by peers [10] , specialist knowledge or clinical experience [9] , [10] , [13] , [18] , [19] , [22] , [23] , based in the relevant jurisdiction [9] , [10] , [18] , [19] , research experience [10] , [22] , [23] , and lack of involvement in product development [13] . In early technology assessment, applications have also looked for other factors such as interaction with colleagues, seen as indicative of the adaptive skills required in this context.…”

“…Many of the applications have included a varied sample of experts by recruiting them from a range of relevant specialties [10] , [12] , [20] , clinical settings [9] , [10] , [20] , and geographical areas/countries [10] , [23] to capture heterogeneity in beliefs (reflecting underlying heterogeneity in patient populations) and avoid dependency between experts [10] .…”

“…Fourteen studies [9] , [10] , [11] , [12] , [13] , [14] , [18] , [19] , [22] , [23] , [24] , [27] , [28] , [35] elicited individually from experts and aggregated mathematically, three aimed to achieve consensus among experts [15] , [17] , [21] , and three others did not explicitly report the method of aggregation used [16] , [20] , [25] ( Table 2 ).…”

“…Administration was via bespoke tools using Excel [9] , [10] , [18] , [19] , [24] , [26] , paper questionnaires, a generic elicitation package (the Sheffield Elicitation Framework) [20] , [21] , and a software package for the elicitation of dependency (Prior Elicitation Graphical Software) [14] ( Table 3 ). Other studies did not specify the mode of administration.…”

“…Elicited evidence has been seen as a way of characterizing uncertainty for model parameters or assumptions to inform the decision to acquire further evidence [9] . In some applications, elicited evidence was used directly as input to the cost-effectiveness model [10] , [12] , [14] , [15] , [20] , [24] . When external evidence existed on elicited parameters, some authors presented both sources separately using scenarios [12] , [17] , whereas others combined them using Bayesian updating [9] , [16] , [21] .…”