Abstract
BackgroundMost available pharmacotherapies for alcohol-dependent patients target abstinence; however, reduced alcohol consumption may be a more realistic goal. Using randomized clinical trial (RCT) data, a previous microsimulation model evaluated the clinical relevance of reduced consumption in terms of avoided alcohol-attributable events. Using real-life observational data, the current analysis aimed to adapt the model and confirm previous findings about the clinical relevance of reduced alcohol consumption.MethodsBased on the prospective observational CONTROL study, evaluating daily alcohol consumption among alcohol-dependent patients, the model predicted the probability of drinking any alcohol during a given day. Predicted daily alcohol consumption was simulated in a hypothetical sample of 200,000 patients observed over a year. Individual total alcohol consumption (TAC) and number of heavy drinking days (HDD) were derived. Using published risk equations, probabilities of alcohol-attributable adverse health events (e.g., hospitalizations or death) corresponding to simulated consumptions were computed, and aggregated for categories of patients defined by HDDs and TAC (expressed per 100,000 patient-years). Sensitivity analyses tested model robustness.ResultsShifting from >220 HDDs per year to 120–140 HDDs and shifting from 36,000-39,000 g TAC per year (120–130 g/day) to 15,000–18,000 g TAC per year (50–60 g/day) impacted substantially on the incidence of events (14,588 and 6148 events avoided per 100,000 patient-years, respectively). Results were robust to sensitivity analyses.ConclusionsThis study corroborates the previous microsimulation modeling approach and, using real-life data, confirms RCT-based findings that reduced alcohol consumption is a relevant objective for consideration in alcohol dependence management to improve public health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2606-4) contains supplementary material, which is available to authorized users.
Highlights
Most available pharmacotherapies for alcohol-dependent patients target abstinence; reduced alcohol consumption may be a more realistic goal
Consumption on previous days and on the same day of the previous week were associated with an increased probability of drinking
As observed in the previous model [16], the present microsimulation model predicted that a decrease in the number of heavy drinking days (HDD)/year by 20 was associated with considerable differences in terms of harmful events avoided
Summary
Most available pharmacotherapies for alcohol-dependent patients target abstinence; reduced alcohol consumption may be a more realistic goal. Using randomized clinical trial (RCT) data, a previous microsimulation model evaluated the clinical relevance of reduced consumption in terms of avoided alcoholattributable events. Using real-life observational data, the current analysis aimed to adapt the model and confirm previous findings about the clinical relevance of reduced alcohol consumption. The World Health Organization (WHO) recently reported that alcohol consumption was identified as an important risk factor for more than 60 different major disorders or injuries [7]. Another recent systematic literature review corroborated the causal impact of average alcohol consumption volume for these conditions and added systematic evidence for infectious disease categories such as tuberculosis or pneumonia [8]
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