Tapering off benzodiazepines in long-term users: an economic evaluation

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Clinical Psychology

Background:

• Economic evaluations of benzodiazepine discontinuation are lacking.
• Long-term benzodiazepine use presents significant public health and economic challenges.
• Understanding the cost-effectiveness of different discontinuation strategies is crucial.

Purpose of the Study:

• To compare the costs and outcomes of tapering off benzodiazepines alone (TOA) versus combined with group cognitive behavioural therapy (TO+CBT) and usual care.
• To conduct a cost-effectiveness analysis from societal and pharmaceutical perspectives.

Main Methods:

• Randomized controlled trial with 180 patients over 18 months.
• Cost-effectiveness analysis including intervention costs, drug costs, healthcare services, productivity loss, and patient costs.
• Primary outcome: proportion of patients discontinuing benzodiazepine use; Secondary outcomes: quality of life (HUI-3, SF-36).

Main Results:

• Both TO+CBT and TOA significantly reduced benzodiazepine costs compared to usual care.
• TOA was more cost-effective than TO+CBT across all perspectives.
• Incremental cost-effectiveness ratios (ICERs) showed TOA yielded significant cost savings, with a payback period of 19 months.

Conclusions:

• Tapering off alone (TOA) is a cost-effective strategy for benzodiazepine discontinuation.
• Adding group cognitive behavioural therapy (TO+CBT) to tapering off provided no significant clinical or economic advantages.
• TOA represents a valuable investment with a demonstrable return in terms of cost savings.