Cost-effectiveness of brief structured interventions to discontinue long-term benzodiazepine use: an economic analysis alongside a randomised controlled trial.

Dominic Trépel,Caterina Vicens,Dean Mcmillan,Simon Gilbody,Alfonso Leiva,Shehzad Ali,Ferran Bejarano,Ermengol Sempere

doi:10.12688/hrbopenres.13049.1

Abstract

Background: In Spain, long-term use of benzodiazepine is prevalent in 7% of the population; however, this longer-term use lacks clinical benefits, costs €90million per year and side-effects further add extra cost through adverse health outcomes. This study aims to estimate the cost-effectiveness of primary care services stepped dose reduction of long-term benzodiazepines using either Structured Interview with Follow-up (SIF) or Without Follow-up (SIW), compared to Treatment as Usual (TAU). Design: Cost-effectiveness analysis was conducted alongside randomised control utilizing data from three arm cluster randomized trial. Setting: Primary care. Participants: 75 general practitioners were randomised to one of the three arms (TAU, SIW, SIF). Measurements: Cost and Cost per Quality-Adjusted Life Year (QALY) Results: Compared to usual care, providing SIW per participant costs an additional €117.94 and adding patient follow-up, €218.4. As a result of intervention, participants showed a gain of, on average, for SIW 0.0144 QALY (95% CI -0.0137 to 0.0425) and for SIF 0.0340 QALYs (0.0069 to 0.0612). The Incremental Cost Effectiveness Ratio was €8190.28/QALY (SIW) and €6423.53/QALY (SIF). At the Spanish reimbursement threshold (€45,000 per QALY) the chance interventions are cost effective is 79.8% for SIW and 97.7% for SIF. Conclusions: Brief structured interventions to discontinue long-term benzodiazepine use represent value for money, particularly with scheduled follow-up appointments, and would represent a cost-effective investment by the Spanish healthcare to reduce prevalence of long-term use.

Highlights

Long-term prescription of benzodiazepines has significant negative outcomes, causing significant costs to healthcare and wider society; many physicians continue to prescribe these and patients wishing to withdraw rarely receive advice or support[1]
We simultaneously examine generic health gains (expressed in Quality-Adjusted Life Years (QALYs))[17,18] and associated costs to healthcare; this aims to inform the decisionmakers by comparing the Incremental Cost Effectiveness Ratio (ICER) against willingness-to-pay threshold[19,20,21]
The relative risks for benzodiazepine discontinuation were 3.01 in the SIW and 3.00 in the Structured Interview with Follow-up (SIF) group compared to usual care

Summary

Introduction

Long-term prescription of benzodiazepines has significant negative outcomes, causing significant costs to healthcare and wider society; many physicians continue to prescribe these and patients wishing to withdraw rarely receive advice or support[1]. Based on the cost of long-term benzodiazepine prescription alone, we estimate the cost in Spain is over €70 million per annum and, if the consequences of associated morbidities were considered, the full economic cost to healthcare is much higher[10]. Economic evidence on benzodiazepine cessation programs report predominantly how costs vary by level of complexity, as studies have tended to report the absolute costs of programs (as opposed to the incremental cost over Treatment as Usual (TAU)). In Spain, long-term use of benzodiazepine is prevalent in 7% of the population; this longer-term use lacks clinical benefits, costs €90million per year and side-effects further add extra cost through adverse health outcomes. This study aims to estimate the cost-effectiveness of primary care services stepped dose reduction of long-term benzodiazepines using either Structured Interview with Follow-up (SIF) or Without Follow-up (SIW), compared to Treatment as Usual (TAU).

Objectives

Methods

Results

Conclusion