Journal Article

Model-based cost-effectiveness analyses comparing combinations of urate lowering therapy and anti-inflammatory treatment in gout patients

Janssen, Carly A., van de Laar, Celine Johanna, Janssen, Matthijs, AL, Maiwenn J., Oude Voshaar, Martijn A. H., van de Laar, Mart A. F. J.

2022

Overview

To assess the cost-effectiveness of various combinations of urate lowering therapy (ULT) and anti-inflammatory treatment in the management of newly diagnosed gout patients, from the Dutch societal perspective. A probabilistic patient-level simulation estimating costs and quality-adjusted life years (QALYs) comparing gout and hyperuricemia treatment strategies was performed. ULT options febuxostat, allopurinol and no ULT were considered. Flare treatments naproxen, colchicine, prednisone, and anakinra were considered. A Markov Model was constructed to simulate gout disease. Health states were no flare, and severe pain, mild pain, moderate pain, or no pain in the presence of a flare. Model input was derived from patient level clinical trial data, meta-analyses or from previously published health-economic evaluations. The results of probabilistic sensitivity analyses were presented using incremental cost-effectiveness ratios (ICERs), and summarized using cost-effectiveness acceptability curves (CEACs). Scenario analyses were performed. The ICER for allopurinol versus no ULT was €1,381, when combined with naproxen. Febuxostat yielded the highest utility, but also the highest costs (€4,385 vs. €4,063 for allopurinol), resulting in an ICER of €25,173 when compared to allopurinol. No ULT was not cost-effective, yielding the lowest utility. For the gout flare medications, comparable effects on utility were achieved. Combined with febuxostat, naproxen was the cheapest option (€4,404), and anakinra the most expensive (€4,651). The ICER of anakinra compared to naproxen was €818,504. Colchicine and prednisone were dominated by naproxen. Allopurinol and febuxostat were both cost-effective compared to No ULT. Febuxostat was cost-effective in comparison with allopurinol at higher willingness-to-pay thresholds. For treating gout flares, colchicine, naproxen and prednisone offered comparable health economic implications, although naproxen was the favoured option.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Allopurinol / Anti-Inflammatory Agents - economics / Anti-Inflammatory Agents - therapeutic use / Anti-inflammatory drugs / Care and treatment / Clinical trials / Colchicine / Comparative analysis / Cost analysis / Cost benefit analysis / Costs and Cost Analysis / Drug dosages / Drug therapy / Drug Therapy, Combination / Economic analysis / Economic aspects / Economics / Gout / Gout - blood / Gout - drug therapy / Gout - economics / Gout Suppressants - economics / Gout Suppressants - therapeutic use / Health services / Humans / Hyperuricemia / Inflammation / Interleukin 1 receptor antagonist / Markov chains / Medicine and Health Sciences / Models, Economic / Naproxen / Pain / Patients / Prednisone / Sensitivity analysis / Social Sciences / Uric acid / Uric Acid - blood / Willingness to pay