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      Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets

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          Heavy alcohol use can cause somatic and mental diseases, affects patients’ social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany.


          In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period.


          Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence).


          n=236 adult patients with alcohol dependence and n=4687 adult individuals without alcohol dependence.

          Primary and secondary outcome measures

          The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated.


          Total 6-month excess costs of €11 839 (95% CI €11 529 to €12 147) were caused by direct excess costs of €4349 (95% CI €4129 to €4566) and indirect costs of €7490 (95% CI €5124 to €9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high.


          Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed.

          Trial registration number


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          Most cited references 25

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          [Calculation of standardised unit costs from a societal perspective for health economic evaluation].

          Due to demographic aging, economic evaluation of health care technologies for the elderly becomes more important. A standardised questionnaire to measure the health-related resource utilisation has been designed. The monetary valuation of the resource use documented by the questionnaire is a central step towards the determination of the corresponding costs. The aim of this paper is to provide unit costs for the resources in the questionnaire from a societal perspective.
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            Missing-Data Adjustments in Large Surveys

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              Comparisons of self-reported and register data on sickness absence among public employees in Sweden.

              Self-reported assessments of sickness absence are often performed in epidemiological studies. The objective of this study was to compare the number of sick-leave days according to self-reported data over 12 months with data from the employer's register for the same period. An additional aim was to ascertain whether the self-reported information and the recorded data would show equivalent associations with self-reported general health. The study was based on a cohort of 4869 municipal employees in Sweden, about 80% women, who answered a questionnaire in 2001-2. The responses provided by the employees included information on number of sick-leave days and self-rated health. Data on sick-leave days, occupation and age were derived from the employers' computerised registers. The questionnaire information on sick-leave days was compared with the corresponding information retrieved from the employer register by means of calculating sensitivity and specificity, using the employers' data as the "gold standard". The annual number of sick-leave days was lower according to the self-reported information than to the register data. For women the agreement between the two sickness absence measures for no sick-leave days, 1-7 days and >/=28 days were 74%, 72% and 67%, respectively. The sensitivity of questionnaire versus register information regarding any self-reported sick-leave day was 91% and the specificity was 74%. Sensitivity and specificity for sickness absence >/=28 days were 67% and 98%, respectively. The results for men were similar to those for women. Self-reported and recorded sickness absence were both associated with self-rated health. The odds ratios were 7.27 and 8.25, for subjects with >/=28 recorded and self-reported number of sick-leave days respectively, compared to subjects with no sickness absence. Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                29 August 2018
                : 8
                : 8
                [1 ] departmentDepartment of Health Economics and Health Services Research , Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf , Hamburg, Germany
                [2 ] departmentDepartment of Medical Psychology , University Medical Center Hamburg-Eppendorf , Hamburg, Germany
                [3 ] IFT Institute for Therapeutic Research Munich , Munich, Germany
                [4 ] departmentDepartment for Public Health Sciences , Stockholm University , Stockholm, Sweden
                [5 ] departmentInstitute of Psychology , ELTE Eötvös Loránd University , Budapest, Hungary
                [6 ] departmentCentre for Interdisciplinary Addiction Research , University of Hamburg , Hamburg, Germany
                [7 ] departmentCentre for Psychosocial Medicine , Health North , Bremen, Germany
                [8 ] departmentLVR-Hospital Essen, Department of Addictive Behavior and Addiction Medicine, Medical Faculty , University of Duisburg-Essen , Essen, Germany
                Author notes
                [Correspondence to ] Dr Judith Dams; j.dams@
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

                Funded by: German Ministry of Education and Research;
                Health Economics
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                excess costs, alcohol, economic burden, cost-of-illness, addiction treatment, economic evaluation


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