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 DepartmentReport as inadecuate




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 - Download this document for free, or read online. Document in PDF available to download.

Applied Health Economics and Health Policy

, Volume 14, Issue 2, pp 205–215

First Online: 30 December 2015DOI: 10.1007-s40258-015-0214-1

Cite this article as: Wilson, E.C.F., Stanley, G. & Mirza, Z. Appl Health Econ Health Policy 2016 14: 205. doi:10.1007-s40258-015-0214-1

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.

Twitter: @EdCFWilson.

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Author: Edward C. F. Wilson - George Stanley - Zulfiquar Mirza

Source: https://link.springer.com/







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