Modelling lifetime QALYs and health care costs from different drinking patterns over time: a Markov model

The negative health consequences of alcohol use and its treatment account for significant health care expenditure worldwide. Long-term modelling techniques are developed in this paper to establish a link between drinking patterns, health consequences and alcohol treatment effectiveness and cost-effectiveness. The overall change in health related quality and quantity of life which results from changes in health-related behaviour is estimated. Specifically, a probabilistic lifetime Markov model is presented where alcohol consumption in grams of alcohol per day and drinking history are used for the categorization of patients into four Markov states. Utility weights are assigned to each drinking state using EQ-5D scores. Mortality and morbidity estimates are state, gender and age specific, and are alcohol-related and non-alcohol-related. The methodology is tested in a case study. This represents a major development in the techniques traditionally used in alcohol economic models, in which short-term costs and outcomes are assessed, omitting potential longer term cost savings and improvements in health related quality of life. Assumptions and implications of the approach are discussed.